HSE SOUTH
Regional Service Plan 2012 9th February 2012
Contents
Introduction to HSE South RSP 2012 ...... 2
Resource Framework...... 9
Improving Quality and Delivering Safe Services...... 13
Service Delivery ...... 19 Promoting and Protecting Health...... 19 Primary Care, Community (Demand-Led) Schemes and other Community Services ...... 24 Hospital Services...... 31 Cancer Services ...... 51 Older People Services...... 57 Mental Health Services...... 64 Disability Services ...... 76 Child Protection and Welfare Services ...... 82 Palliative Care ...... 89 Social Inclusion...... 93
Appendices...... 97 Appendix 1 – Financial Information ...... 97 Appendix 2 – HR Information ...... 98 Appendix 2 – Health Sector PSA Implementation Plan...... 100
Introduction - Regional Director of Operations
The Chief Executive Officer, Mr Cathal Magee, published the HSE National Service Plan 2012 (NSP) on the 13th January, 2012, having been approved by the Minister for Health & Children. This HSE South Regional Service Plan has been prepared consistent with these national policies, frameworks, performance targets, standards & resources. The Regional Service Plan sets out the type and volume of service the HSE South will provide directly or through a range of agencies funded by us during 2012.
Resources for 2012 A summary of the funding and staff numbers available to deliver the Regional Service Plan is outlined in the Resource Framework on the next section of the plan. The detail of funding, staff numbers and the service delivery plan for the year in each care group or service is outlined under each section of the plan.
Finance While the gross reduction in budget for the HSE South in 2012 amounts to €208m, this does not represent the service impact this year. Comparisons between gross budget figures for 2011 and 2012 are difficult this year as there has been a significant reorganisation of some funding streams, e.g. Fair Deal has been centralised nationally. These changes together with the income measures and related issues amount to €142m which can be regarded as non-service impacting in 2012. Furthermore additional funding of €14m has been provided in respect of children’s services, to address some service pressures and to allow some limited and targeted recruitment in priority areas to help limit the impact of retirements on frontline services. When the budget is adjusted for these figures, the budget reduction for the South in 2012 which is service impacting amounts to €80m (3.7%). In addition the underlying deficit and service pressures from 2011, which will need to be addressed in 2012, amounts to €35m (1.8%), which presents a resource challenge of €115m (5.5%) for HSE South in 2012.
Staff Numbers Apart from this overall budget reduction, a significant challenge for the HSE South in 2012 will be managing the reduction in levels of staff employed arising from the retirements associated with the grace period in February 2012. In addition, the government policy to reduce the size of the public sector and overall employment levels through the moratorium will continue. The cumulative impact on staff reductions from this year and previous years will present a significant challenge for the HSE South in delivering services. The reduction in staff numbers in HSE South over the past number of years can be summarised as follows:
. 2,276 staff reduction since 2007 peak . 1,412 less staff at end 2011 than started 2010 . 1,000 staff left in 2011
The table below outlines the number of WTE staff who will be retiring on an area & care group basis from November 2011 to February 2012. It also identifies the numbers retiring as a percentage of our overall workforce. In all, this represents 736 individuals who have left since November 2011. A further 173 individuals had left the service between Sept to Nov 2011 (excluding Corporate and Home Helps) bringing the overall total to 909 individuals.
WTE as % of Care Group CK/ST Cork Kerry WT/WX Total Care Group Resource Acute Hospitals 35 101 17 61 214 (2.0%) Children & Families 4 8 1 10 23 (2.3%) Disabilities 8 45 17 70 (2.1%) Mental Health 38 56 19 11 124 (4.9%) Older People 43 67 34 27 171 (5.2%) Primary Care 3 12 4 4 23 (1.8%) Social Inclusion 1 1 (0.9%) Grand Total 131 290 76 129 626 (2.8%)
. 736 individuals equating to 626 WTE have notified that they will retire (in the period Nov11 to Feb12) – Nursing 371 WTE (4.3%) of which • Acute 114 WTE (2.6%) • Mental Health 97 WTE (6.3%) • SOP 124 WTE (7.5%) • Disabilities 30 WTE (3.7%) – General Support staff 69 WTE (2.5%) HSE South 2 INTRODUCTION
– Other patient & Client Care (HCA’s) 60 WTE (1.9%) – Health & Social Care Professionals 55 WTE (1.7%) – Management / Admin 43 WTE (1.6%) – Medical Dental 29 WTE (1.7%)
Responding to the Resource Challenge–Minimising impact on Frontline Services Work has been underway since Autumn 2011 in preparing for the reduction in staff numbers with many of these staff having retired which can be seen from the figures outlined above. This Regional Service Plan has been prepared taking account of the overall reduction in resources in terms of both budget reduction and staff numbers leaving.
The HSE South is seeking to mitigate the impact of the retirements on frontline services in a number of ways: – by using the provision of the Public Service Agreement to bring about greater flexibilities in work practices and rosters, redeployment and other changes to achieve more efficient delivery of services. – Delivering greater productivity through the National Clinical Programmes to reduce the average length of stay, improve day of admission surgery rates, increase the numbers of patients treated as day cases, etc. – Some limited and targeted recruitment in priority areas to help limit the impact of retirements on frontline services.
If we are to successfully implement the Regional Service Plan, the fundamental challenge for HSE South in 2012, is to: . Fast-track implementing our change programmes – New, innovative and efficient ways of using a reducing resource – Challenging traditional cost structures & models of service delivery – Implementing the health reform programme
. Move to new models of care across all services & Care Groups which; – Deliver at the lowest level of complexity – Provide services at the lowest possible unit cost – Reorganisation of hospital services & implementing National Clinical Programmes – Improvement programmes across all Care Groups based on agreed national policies, e.g. Vision for Change, VFM report in Disability, Primary Care Strategy
. Our HR Strategy and workforce plan will be implemented to ensure that staff resources are allocated to the area of greatest priority with a strong focus on – workforce planning – redeployment to match staffing resources with service & activity priorities – Review of rostering arrangements – Enhancing skill mix where appropriate in care areas
Public Sector Agreement The Public Sector Agreement provides the framework for delivering on this significant change programme across the HSE South during the course of 2011. It provides a unique opportunity to further transform and modernise the health services by facilitating a reduction in staff numbers, increasing efficiency and productivity, reducing costs and improving quality.
During 2012 there has been very positive engagement on implementing major change programmes across all four areas of HSE South with clear evidence of new ways of working and with a strong “can do” attitude. Staff are responding in a proactive manner to the change agenda with a developing awareness that each staff member has a contribution to make to the viability of our services and maximising sustainable employment. The Public Service Agreement has served us well to date in the South, and the challenge now, is to increase the pace of change as we implement new ways of working to deliver on the 2012 Regional Service Plan. I am confident that we can all respond to this challenge, which will see HSE South as a high performing area, which continues to value the contribution of all staff.
We are already working closely with staff and their staff associations through a detailed information and consultation process at local and regional level. This engagement will see a move to new models of care across all services which deliver at the lowest level of complexity and at the lowest possible unit cost. Our focus will be on maximising new and innovative service delivery options with a shared ownership of the reform agenda. We will maintain our high performance culture with the emphasis on implementation and delivery. An outline of the range of planned changes is set out in Appendix 3. This appendix is not an exhaustive list of initiatives underway but serves as an illustration of some of the key change initiatives being undertaken across HSE South 3 INTRODUCTION
HSE South. I wish to acknowledge the active participation by staff and the staff associations in engaging in this process. Regional and local meetings have been taking place through which the initiatives are being discussed and progressed. This is a dynamic process and will continue to develop and evolve as the year progresses and as we monitor and evaluate progress in collaboration with staff and their representative bodies.
Service Delivery Impact in 2012 Acute Services The budget reduction for Acute services in the South which is service impacting amounts to €28m. This represents a reduction of (3.76%). In addition the underlying deficits and service pressures from 2011 which will need to be addressed in 2012 amounts to €26.411m (3.54%). There are 214 staff WTE (2%) who will leave the service as a result of the grace period 2012. To address the funding issues and reduction in staff numbers a range of measures are being implemented for Acute services in 2012 as summarised below:
The strategy across acute hospitals in the service plan will be to mitigate the impact of budget and staff reductions through rigorous implementation of the clinical programmes particularly in Acute Medicine, Emergency Department and Surgery within the hospitals, in an accelerated way. The capacity in the system will be tailored to available funding and staff resources to ensure a sustainable model of service delivery. Through this approach it is hoped to reduce on average the impact on services and activity by approximately 3%. This will involve: . Planned seasonal bed closures – comprehensive structured annual leave planning – redeployment . Top priority AMP, Surgery, ED-Supported by Stroke ACS, COPD, OPD programme . Increase move from inpatient to day care across all hospitals . Increased rate of elective patients with procedures performed on day of admission. . Reduce average length of stay . Maximise numbers treated . Reduce numbers of beds required
Overall additional investment of €6m is being provided to support the change initiatives including the appointment of 50 additional staff including 20 Consultant posts. Given that CUH is a regional hospital & cancer centre which also provides a significant range of national specialties, and WRH being the south east cancer centre and having a regional service component, these two hospitals are prioritised in the allocation of the development funding receiving €1.9m and €2m respectively. However, each hospital in the region is being provided with some additional resource to support their overall implementation of the national clinical programmes. The details are outlined in the individual hospital schedules in the following pages.
Additional resources are provided to support the implementation of the Clinical Programmes & the SDU initiatives as outlined in the plan. Each hospital will be required to implement the total package of initiatives including a breakeven funding position as part of their 2012 plan. Arrangements are already underway to implement the overall change programme with support from the National Clinical Leads and SDU as required throughout the year. The net effect is that the capacity is being tailored to the available funding and staff resources to ensure a sustainable model of service delivery which is safe and responsive to the needs of the public.
Primary Care The budget reduction for Primary Care in the South amounts to €5.960m which represents a 5% reduction. There are 23.5 WTE staff who will leave the service in the context of the grace period 2012 representing 1.8%. To address the funding issues and reduction in staff numbers a range of measures necessitated for Primary Care services in 2012 are summarised below.
Our vision for primary care is that the health of the population will be managed, as far as possible, within a primary care setting, with the population very rarely requiring admission to a hospital. Those with additional or complex needs will have plans of care developed with the local Primary Care Team (PCT) who will co-ordinate all care required with specialist services in the community and, for hospital attendance, through integrated care pathways.
Our overall approach is to deliver services at the lowest level of complexity which are available locally to maximise health outcomes whilst reducing the need for patients to travel outside their communities. The structured delivery of primary care will support the transfer of appropriate care from the acute hospital sector towards the primary care setting.
Efficiencies will be achieved regionally in line with national measures including national pharmacy agreements, and also through ongoing work with the Primary Care Reimbursement Scheme. Every effort will be made to minimise the impact of the budget reductions on frontline service provision.
HSE South 4 INTRODUCTION
We will also continue to enhance our primary care accommodation with the provision of 4 new Primary Care Centres in 2012. Service priorities for 2012 include the continued focus on chronic disease management programmes with initiatives in selected primary care teams across the region. In addition we will continue to expand and further develop Community Intervention Teams in selected locations throughout the South.
Mental Health The budget reduction for mental health services in the South amounts to €11.455m which represents a 6.1% reduction. There are 124 WTE staff who will leave the service in the context of the grace period 2012 representing 4.9%. To address the funding issues and reduction in staff numbers a range of measures necessitated for mental health services in 2012 are summarised below.
We will be maximising the reorganisation of rostering, reduction in overtime and agency, and increasing skill mix and other measures to limit the impact on frontline services. Priority posts will be filled on a targetted basis within the service. The re-organisation of services in line with A Vision for Change will support the development of community services while at the same time reduce the overall cost of services, maximising the benefit to service users.
The HSE South plan for Mental Health Services includes a range of measures aimed at improving service user health, independence and experience and, at the same time, continuing to reconfigure service delivery to ensure increased efficiency. In line with the modernisation and reconfiguration of services envisaged in A Vision For Change, HSE South continues to accelerate the programme of closure of old long-stay institutions, reduce dependency on inpatient beds and prioritise the development of community based Mental Health Services across the four extended Catchment Areas.
The priority service focus in HSE South in 2012 will be;
. To complete the implementation of reconfiguration of services in line with Vision for Change in Waterford/Wexford and Carlow/Kilkenny & South Tipperary areas. . To fully implement the recommendations of the Mental Health Commission in relation to the Kerry services. . The priority in the Cork services in 2012 will be to significantly progress implementation of a Vision for Change. A Project Implementation Group representative of all stakeholders is being established to determine how the service will change to focus on a recovery and community based model of service delivery in Cork. This project implementation group will be provided with an overview of the work undertaken to date by a multidisciplinary group of clinicians and managers across all mental health services in Cork. A senior manager will be appointed to chair the group which will report by the end of the first quarter with the intention of proceeding with implementation on a phased basis over the reminder of the year.
In line with the Programme for Government, funding of €35m is being provided nationally to enhance General Adult and Child and Adolescent Community Mental Health teams, improve access to psychological therapies in Primary Care and implement suicide prevention strategies in line with Reach Out – National Strategy for Action on Suicide Prevention. Nationally 400 staff have been made available to support this. The HSE South will receive an appropriate allocation from this resource, which will assist in progressing implementation of the overall programme and to fill priority posts or gaps in service which may arise.
Services for Older People The budget reduction for Services for Older People excluding Fair Deal in the South amounts to €8.959m which represents 4.5%. There are 171 WTE staff who will leave the service in the context of the grace period 2012 representing 5.2%. To address the funding issues and reduction in staff numbers a range of measures necessitated for Service for Older People in 2012 are summarised below.
Significant progress has been made across HSE South in developing an integrated model of care in Services for Older People ensuring that Older People with complex care needs are supported appropriately through the developing PCTs and with appropriate access to specialist care by way of Consultant Geriatrician input. Overall there is an increase in the levels of dependency of older people living at home and receiving significant and multi disciplinary service levels.
The ongoing roll out and development of the integrated model of care is ensuring that the various options within residential care, particularly in relation to rehabilitation and convalescence will be best utilised, to ensure that they provide value for money and that those in need of such services receive them as a matter of priority.
HSE South 5 INTRODUCTION
While there will always be a need for older people to access acute hospital care it is vital that once the acute episode has been addressed that they can access the appropriate service at home or by way of rehabilitation etc to ensure that they can maintain or improve their level of independence.
Having regard to the budget reduction and the numbers retiring it will be necessary to significantly reorganise our rostering arrangements, staffing levels and work practices as well as revising the Skill-mix of our staff and maximise the opportunities for redeployment to ensure that we minimise the impact on the reduction of public residential beds and the broader range of community services.
. Prioritising Residential Beds In 2012 the HSE South will provide over 2,100 public residential care beds in 40 units (including the new Tralee CNU) providing long stay beds and short term respite, rehabilitation and convalescent care. Each of the 4 Areas across the HSE South has undertaken a comprehensive assessment of capacity and resource availability associated with this service for the coming year. The areas undertook the review based on a number of factors : – Demand for beds particularly choice of care by applicants for long stay beds through the Nursing Home Support Scheme ( Fair Deal) process – Estimated number of retirements of care staff to end of February 2012 and to year end – Cost of care in the unit and the potential / need to economise through roster changes and skill mix adjustments – Audit of compliance of each unit with current and future HIQA environmental standards and in particular Fire Safety Standards and Legislation – Review of HIQA inspection reports by unit to identify improvements required to meet standards particularly care related issues – Cost of level of agency/cost containment and requirements for 2012 – % occupancy of all public beds ( long stay and community supports) and profile and trend of patient use of these beds
Following the comprehensive assessment undertaken utilising the criteria outlined above, the position in relation to bed closures in HSE South has been revised downwards from a proposed minimum figure of 180 in the NSP to a planned reduction of 128 public residential care beds.
The successful implementation of our change programme and implementation of the model of care for older people will be a critical factor in enabling HSE South to minimise the impact on public long stay bed provision and full cooperation will be required from all stakeholders if this is to be achieved.
An important factor in the overall consideration of residential care bed closures was the fact that 101 of the 128 beds proposed for closure are currently vacant due to the staff retirements and reduction in agency costs as well as the demand for the Nursing Home Support Scheme, HIQA environmental standards, etc.
. Community supports The priority in HSE South for 2012 will be to maintain Home Care Packages at 2011 levels. We will minimise the impact of the 4.5% reduction in home help hours through concentrating the resource in supporting personal care and necessary domestic duties. In refocusing our Home Help service, we will maximise the no. of working hours for existing Home Helps within the system. All high dependency clients will receive a service. Clients with low dependency may not be eligible for a service as heretofore; however, those applicants will be linked into other services and advised of the various supports available.
Disability Services The budget reduction for Disability Services in the South amounts to €11.576m which represents a reduction of 3.7% There are 70 WTE staff who will leave the service in the context of the grace period 2012 representing 2.1%. To address the funding issues and reduction in staff numbers a range of measures necessitated for Disability services in 2012 are summarised below.
. Progress implementation change programme based on DOH policy set out in VFM & policy review . Develop a community based & inclusive model rather than institutional segregated . Budget & staff reductions will be focused on – Efficiency – Consolidation – Reorganisation – Rationalisation of back office activity . Some impact on services unavoidable but tailored to minimise impact to service users. . Disability services will be required to cater for demographic pressures, such as new services for school leavers and emergency residential placements, from within their existing budgets.
HSE South 6 INTRODUCTION
A major change programme for disability services in Ireland has commenced in recent years. Service provision has been moving towards a community-based and inclusive model rather than being institutional and segregated. The emerging DoH policy direction (Value for Money and Policy Review), coupled with recommendations from HSE national working groups on key service areas such as congregated settings and day services, has emphasised the need for a new model of service provision that, if agreed by Government, will further the independence of people with disabilities in a manner which is efficient and cost-effective. The findings and recommendations of the Value for Money and Policy Review will provide the framework within which the constituent parts of the overall change programme will be developed and driven. This radical change is not the sole responsibility of the HSE but, rather, a collaborative responsibility shared between the person, their families and carers, a multiplicity of agencies, Government, and society as a whole. It will be a priority for HSE South to engage positively in implementing this approach in 2012.
Child Care Services Child Protection and Welfare Services have had an increase of €3.139m (2.7%) in budget in HSE South. However, this increase is against a backdrop of budgetary over runs in 2011 and cost management measures are required to reduce the cost base as set out below: There are 23 WTE staff who will leave the service in the context of the grace period 2012 representing 2.3%.
Under the Programme for Government, fundamental changes as to how child and family services are delivered in Ireland are proposed in order to develop a service that is fit for purpose. These changes will be achieved firstly through the delivery of a major reform programme for family support, child protection and alternative care, accompanied by the associated changes in management structures. The financial challenge in the short to medium term will be examined and the method of allocating resources reviewed.
Budgetary over runs in 2011 and cost management measures are required to reduce the cost base as set out below: . Reduce costs related to private residential care provision by maximising capacity in HSE services and reduce reliance on additional external provision. . Establish standardisation of approach and payments across the region for After Care Services. . Reduction in costs associated with agency staffing through management of absenteeism and re- organisation of staff rosters. An independent review of staff rostering in HSE residential units is currently taking place in order to facilitate a more flexible approach in the services provided. It is envisaged that following the review more efficient rosters will be established providing greater capacity and cost savings. . Reduction in funding to voluntary agencies in line with national direction . Back office services efficiencies / reduction in travel expenses, procurement etc. . Reduction in level of enhanced Foster Care payments and limits on discretionary payments in excess of standard weekly foster care payment. No reduction in service anticipated.
Social Inclusion & other services The budget reduction for Social Inclusion services in the South amounts to €1.2m which represents a reduction of 6.3%. There are 0.7 WTE staff who will leave the service in the context of the grace period 2012 which represents a reduction of 0.9%. To address the funding issues and reduction in staff numbers a range of measures necessitated for Social Inclusion and other services in 2012 are summarised below.
HSE South Social Inclusion services improve access to mainstream services, target services to marginalised groups, address inequalities in access to health services and enhance the participation and involvement of socially excluded groups and local communities in the planning, design, delivery, monitoring and evaluation of health services. The budget reduction for social inclusion services in the South amounts to €1.22m which represents a 6.3% reduction. Efficiencies will be achieved in non pay expenditure in core budgets and regional committee core budgets. In addition, there will be some reduction in Voluntary Agencies funding. The Social Inclusion team including the Community Workers, Drug & Alcohol Addiction teams as well as Homeless services and the Travelling Community will work with all our care groups and services to ensure that we continue to support the most vulnerable within our community, while at the same time implementing the Regional Service Plan in line with the national framework.
Potential Risks to the delivery of Regional Service Plan 2012 There are a number of potential risks which may impact on the delivery of the regional service plan, including Service, HR & Finance risks. These are set out on pages 9 & 10 of the National Service Plan and in the region we monitor and assess all of these and other risks that emerge as 2012 progresses and dependent on their impact, we may need to adjust planned service levels during the year to ensure that we can operate within the resources provided.
HSE South 7 INTRODUCTION
Quality, Risk & Clinical Care The HSE South is committed to delivering high quality services to all our patients and clients and to creating a quality promoting workplace for staff. An important task for us all is to ensure that our services are safe; this is achieved through the implementation of a comprehensive quality and patient safety framework and by mitigating risk in the operational health system. We must also make sure that where serious incidents do arise that we manage our response effectively and implement appropriate measures in order to improve our systems. Ensuring compliance with national standards in relation to quality & patient safety will be an increasing focus for our services in 2012. Significant progress is already being made across hospitals and community services at local level and to support this work we have put in place in 2011 a more comprehensive regional Quality and Patient Safety Programme, which we are now rolling out at Area Level in 2012, the detail of which is outlined on page 13 of this plan.
Conclusion This Regional Service Plan can only be delivered through the collective efforts of the Health and Social Care professionals from all of our care disciplines and services. Our services are now more than ever dependent on our staff to continue to make the extra effort for all our patients and clients. HSE South has a strong tradition in delivering fully on our service plan targets. This is a reflection of the high calibre and the exceptional commitment of the individual staff and teams and I wish to thank all staff for their contribution to date and look forward to the continuation of this commitment in 2012.
HSE South 8
Resource Framework
Introduction This HSE South Regional Service Plan has been prepared consistent with national policies, frameworks, performance targets, standards and resources and sets out the type and volume of service the HSE South will provide directly or through a range of agencies funded by us during 2012.
The decisions which the Regional Management Team has taken in the allocation of resources and the prioritisation of services and cost measures were carefully considered so that we would be in a position to continue to deliver high quality responsive services and continue to support the most vulnerable while implementing the key HSE national priorities for 2012.
Finance It is important to acknowledge that a significant effort has been made this year to ensure that cost reduction measures are implemented in a way which minimises the impact on front line services at regional and local level.
HSE South €m Base Budget 2011 1,898.606 Cost reductions – service impacting (80.307) Cost reductions – non-service impacting (142.631)* Additional Funding 14.287** Sub-total (208.651) Budget 2012 1,689.955
WTE Ceiling Start 2012 22,324
* The non service impacting reductions include a budget retraction amounting to €116.512m in relation to Fair Deal which will be managed as a centralised national budget in 2012. **Additional Funding was received in respect of childcare (€10.000m), replacement of non exempt staff (€3.287m) and service pressures (€1.000m).
In addition, a range of measures to address the 2011 excess run rate including once off savings in 2011 will also have to be implemented in 2012. This equates to €35.221m, which represents an additional 1.8% reduction, which is split between hospital €26.411m and community €8.810m. The range and quantum of services to be provided in 2012 takes account of the reduction in 2012 budget, together with residual underlying deficits and cost pressures and the decrease in staffing levels.
Pay and pay related expenditure €m Adjustments for 2012 Recruitment moratorium 32.850 Overtime reductions 1.562 Premium pay 1.845 Sick leave 1.386
Sub total 37.643
There are critical linkages between a number of pay-related elements in this plan. These elements cannot be considered in isolation and must be offset against each other depending on the number of staff who leave under the ‘grace period’, their salary level and their length of service. To the extent that staff do not leave as provided for within this plan, pay savings will not be delivered and the resulting shortfalls must be offset by the funding provided for lump sums.
HSE South 9 RESOURCE FRAMEWORK
Human Resources In the HSE South . 2,276 staff reduction since 2007 peak . 1,412 less staff at end 2011 than start of 2010 . 1,000 left in 2011 . Over 400 WTE indicated departure by end of February 2012
With a permanent reduction in the overall levels employed in the public sector, management will be required to prioritise services to ensure that the impact on frontline services is kept to a minimum. Such an approach will require re-deployment and re-assignment of staff right across all of our functional areas.
There is a requirement that our cost base be adjusted in line with budget requirements and our focus must be on reform of traditional cost structures and models of service delivery.
As part of our ongoing reform, we will also maximise the reorganisation of rosters, reduction in overtime and agency, and increasing skill mix and other measures to limit impact on frontline services.
This service plan has been developed on the basis that the full budget reduction has been applied across all care groups including acute services, detailed cost containment plans have been drawn up to meet the reductions required. Work is continuing on these plans and will be finalised over a number of weeks in consultation with the national system. There is continuous assessment of the service implications associated with these cost management plans.
In the resource framework outlined above the moratorium (€32.8m) is the main contributory factor to the budget reduction of €80m. The capacity of the service to deliver on this aspect of the plan is limited by the extent to which staff retire or resign during the year and we have emphasised the link between this and the nationally held pension budget. Further work remains to be done to finalise how this overall issue will be handled in 2012. This may not crystallise until February 2012 and the regional service plan may need to be revised in that context.
Contingency Measures Specific contingency measures will be in place across all services to respond appropriately to meet local service demands: . Optimising deployment of staff . Revising/re-working of rosters . Deployment of staff to high risk areas . Closer management of sick leave . Maximising potential of shared service functions . Maximise use of technology to facilitate redeployment of staff . Relocation of workload . Review management/governance structures . Maximise potential for skillmix . Match between service level activity and staffing levels and appropriate use of skill mix . Limited recruitment and conversion of agency and overtime
Implementing our Change Programmes A major theme of the HSE South Regional Service Plan 2012 is to continue the implementation of our national clinical programmes across our hospital system. In addition to these national programmes, our own reorganisation plans for the acute hospital services will continue as core elements of the change programme in the region. Similarly, a range of innovative change programmes will be implemented across our social care services and care groups. The implementation of the change programmes highlighted above will support the reorganisation and development of service across primary, community & hospital services to focus on the complete needs of the patient or client, while also prioritising effective working relationships across services and providing a more responsive and accountable service.
Public Service Reform through full utilisation of Public Service Agreement The regional service plan is focused on: . Placing customer service at the core of everything we do . Maximising new and innovative service delivery channels . Radically reducing our cost to deliver better value for money . Strong focus on implementation and delivery
HSE South 10
RESOURCE FRAMEWORK
The Public Service Agreement (PSA) continues to provide the framework for delivering on this significant change programme across the health sector. It provides a unique opportunity to further transform and modernise the health services by facilitating a reduction in staff numbers, increasing efficiency and productivity, reducing costs and improving quality.
In 2011 HSE South delivered major change programmes in both acute and community services, for example, the reorganisation of mental health services in Waterford / Wexford and Carlow/ Kilkenny/South Tipperary consistent with Vision for Change. In the Cork area a major reorganisation of acute services has delivered major change in orthopaedics, cardiology, medical rehabilitation, ED, and older peoples services. Approximately 1,000 staff were involved in these changes.
We have worked closely with staff and their staff associations to deliver on these changes and will continue to build on this in 2012.
2012 will require an increase in the pace and delivery of change. It is fundamental that there is full engagement on the reform agenda by all stakeholders within specific timeframes. There is a requirement for strong leadership and management of the reform programme with a relentless focus on service and results and through the effective engagement with all of our staff.
Monitoring and Measuring RSP 2012 Performance management in the region is led by the RDO & Regional Management Team. Performance is managed through specific workplans which set out clear outcomes, timelines and responsibilities in each area, which also identify the named individuals to which they are assigned. The 2012 Performance Scorecard is the National Scorecard by which performance is assessed against the three criteria of quality, access and resources and this will be used in conjunction with existing performance management processes to deliver on this Regional Service Plan.
HSE South 11
RESOURCE FRAMEWORK
National 2012 Performance Scorecard
Acute Care Programme Areas Non-Acute Care Programme Areas Performance Indicator Target Performance Indicator Target 2012 2012 HCAI Health Protection < 0.067 Rate of MRSA bloodstream infections in acute hospitals per 1,000 % of children 24 months of age who have received three doses 95% bed days used of 6 in 1 vaccine Rate of new cases of Clostridium Difficile associated diarrhoea in < 3.0 % of children 24 months of age who have received the MMR 95% acute hospitals per 10,000 bed days used vaccine Re-Admission % of first year girls who have received the third dose of HPV % of emergency re-admissions for acute medical conditions to the 9.6% vaccine by August 2012 80% same hospital within 28 days of discharge Time to Surgery Child Health % of emergency hip fracture surgery carried out within 48 hours (pre- 95% % of new born babies visited by a PHN within 48 hours of 95% op LOS: 0, 1 or 2) hospital discharge Stroke Care % of children reaching 10 months in the reporting period who At least
Quality Quality % of patients with confirmed acute ischaemic stroke in whom have had their child development health screening on time before 7.5% 95% thrombolysis is not contraindicated who receive thrombolysis reaching 10 months of age
% of hospital stay for acute stroke patients in stroke unit who are Child Protection and Welfare Services admitted to an acute or combined stroke unit. 50% % of children in care who have an allocated social worker at the 100% end of the reporting period ACS % of children in care who currently have a written care plan, as % STEMI patients (without contraindication to reperfusion therapy) 50% defined by Child Care Regulations 1995, at the end of the 100% who get PPCI reporting period Primary Care No. of Health and Social Care Networks in development 79 Unscheduled Care Child and Adolescent Mental Health % of all attendees at ED who are discharged or admitted within 6 0% 95% % on waiting list for first appointment waiting > 12 months hours of registration % of patients admitted through the ED within 9 hours from Disability Services registration 100% No. of PA / home support hours used by persons with physical 1.64m and / or sensory disability Elective Waiting Time Older People Services 0% % of adults waiting more than 9 months for an elective procedure % of complete NHSS (Fair Deal) applications processed within 100% four weeks % of children waiting more than 20 weeks for an elective procedure 0%
Colonoscopy / Gastrointestinal Service No. of people being funded under NHSS in long term residential
No. of people waiting more than 4 weeks for an urgent colonoscopy 0 care at end of reporting month 23, 611
% of people waiting over 3 months following a referral for all No. of persons in receipt of a Home Care Package 10,870 < 5% gastrointestinal (GI) scopes ALOS % of elder abuse referrals receiving first response from senior Medical patient average length of stay (ALOS) 5.8 case workers within 4 weeks 100% Delayed Discharges Reduce by Palliative Care Reduction in bed days lost through delayed discharges 10% % of specialist inpatient beds provided within 7 days 91% Access and Activity Access and
Cancer Services % of home, non-acute hospital, long term residential care % of patients attending lung cancer rapid access clinic who attended delivered by community teams within 7 days or were offered an appointment within 10 working days of receipt of 95% 79% referral
% of patients attending prostate cancer rapid access clinics who Social Inclusion
attended or were offered an appointment within 20 working days of Traveller Health – No. of clients to receive health awareness 90% receipt of referral raising / screening programmes (breast check, cervical smear screening, men’s health screening, blood pressure testing) 1,650 % of patients undergoing radiotherapy treatment for breast, prostate, through the Traveller Health Units / Primary Health Care Projects lung or rectal cancer who commenced treatment within 15 working 90% days of being deemed ready to treat by the radiation oncologist Finance Human Resources Variance against Budget: Income and Expenditure < 0% Variance against Budget: Income Collection < 0% Variance from approved WTE ceiling < 0% Variance against Budget: Pay < 0% Absenteeism rates 3.5%
Resources Variance against Budget: Non Pay < 0% Variance against Budget: Revenue and Capital Vote < 0%
HSE South 12
Improving Quality and Delivering Safe Services
Introduction Designing and delivering services, to ensure high quality safe services for all our patients and clients, is our primary concern. We are focusing on the development and implementation of safe quality healthcare, where all service users attending our services receive high quality treatment at all times, are treated as individuals with respect and dignity, are involved in their own care, have their individual needs taken into account, are kept fully informed, have their concerns addressed, and are treated / cared for in a safe environment based on best international practice. We are also focusing on achieving the above standards in an environment that is safe for our staff. The National Standards for Safer Better Healthcare, when launched, will outline to the public what can be expected from their healthcare services, while also outlining to service providers what is expected of them. The standards will help to drive improvements for patients by creating a common understanding of what makes a good, safe, health service. We will embrace the National Standards and will seek to support frontline services to drive quality improvement in response to these standards. We will also seek to support service providers by ensuring the overall burden of regulation and standards is managed in a coherent fashion. This is particularly important as we prepare for the roll out of licensing of healthcare provision. Improving quality and delivering safe services is implicit and embedded in the delivery of all our services. Relevant quality metrics are contained within the performance indicators of the appropriate service sections in this plan.
Our priorities for 2012: . Progress the development of the Patient Safety Authority through engagement with the DoH and Health Information and Quality Authority (HIQA). . Develop a strong system of corporate and clinical governance throughout the HSE. . Ensure there is a system-wide co-ordinated approach to the quality agenda that spans the spectrum of service provision and covers regulatory standards, recommended practices, and quality and safety issues. . Implement national and international standards and recommended policies / guidelines developed by HSE, the National Clinical Effectiveness Committee, Government and other regulatory bodies. . Strengthen patient and service user input through developing and implementing best practice models of customer care and service user involvement. . Further embed integrated risk management across all services. Utilise the risk register mechanism as part of the HSE control framework. Learning from the HSE incident experience must inform the work, and the priorities, for the risk register and controls assurance. . Provide transparency and accountability to the public about quality and safety of care by: - Responding to, reporting on, and learning from incidents and adverse events. - Implementing learning from report and review recommendations, risk analysis, serious incidents, audits, complaints, and surveys, and ensure that best practice is shared and distilled. This will prevent and minimise avoidable repeat incidents. - Enhancing quality, clinical and social care audit and assurance. . Improve prevention, control, and management of healthcare-associated infections and improve antimicrobial stewardship. . Continue to provide assurance to the organisation on the implementation, monitoring, and evaluation of the above priorities. . Capture and provide robust intelligence information and evidence to support decision making.
Regional Quality and Patient Safety Programme Purpose The purpose of the programme relates to conformance with and performance of the Quality and Patient Safety system in place in the region as follows;
1. Conformance – to provide assurance to the RDO and Regional Management Team in relation to the systems and processes that are required to manage issues relating to quality and patient safety. This includes compliance with relevant standards (Mental Health Commission (MHC)), Health Information Quality Authority (HIQA) standards, the HSE’s Integrated Risk Management Policy - the systems for the reporting and management of incidents (to include serious incidents), the HSE Medical Device and Equipment Management Policy, the HSE Procedure for the Development of Policies, Procedures, Protocols and Guidelines etc. 2. Performance - to place an emphasis on incremental improvement and increasing safety for those who work in and access services in the region. This will be achieved through monitoring of trends that may indicate underperformance and the identification and exploration of best practice models to improve performance in these areas.
HSE South 13 QUALITY AND SAFE SERVICES
The programme recognises that quality and risk management is a line management responsibility and seeks to support, enable and advise line management. In order to provide organisational assurance surveillance and monitoring will be a key aspect of the programme.
Objectives . To outline the accountability arrangements for Quality and Patient Safety management within the Region and to have in place a structure for Quality and Patient Safety that ensures clear lines of accountability for quality and risk management leading up to the Regional Director of Operations (RDO). . To ensure that the core processes for quality and patient safety are defined, communicated and implemented in a consistent manner in all areas within the Region e.g. risk registers, incident management (including the management of serious incidents), serious incident escalation, compliance with relevant standards, quality improvement programmes etc. . To support the development of capacity and capability of staff in the region with respect to the requirements of the quality and patient safety programme. . To provide mechanisms to support the professional development and networking of quality and risk staff within the region. . To support the development of mechanisms to promote best practice and share learning to improve quality and patient safety . To collaborate with the National and other three Regional HSE Quality and Patient Safety Departments functions to ensure alignment with National Quality and Patient Safety Programme. . To monitor the outcomes of the Quality and Patient Safety Programme by way of measuring Healthcare Quality Indicators. . To provide the RDO and Regional Management Team with assurance in relation to the progress and performance of the regional quality and patient safety programme.
Scope Accepting that quality and patient safety is a line management function, the scope of this programme is one of establishing and monitoring consistent frameworks and providing advice and support to enable their implementation.
Organisational Arrangements This programme is predicated on the basis of a Quality and Patient Safety Department which oversees the programmes of work and a related governance structure which in turn ensure embedment at all levels in the services.
The organisational arrangements for the operation of the Quality and Patient Safety department and Regional Quality and Patient Safety governance structure are outlined below.
Regional Quality and Patient Safety Department Function
Figure 1
Regional Quality and Patient Safety Programme
Risk Management Assurance Quality Improvement (Reactive and and Innovation proactive)
Process Assurance, Surveillance, Improvement, Facilitation
Data and Information Management Support Team
HSE South 14
QUALITY AND SAFE SERVICES
Regional Quality and Patient Safety Governance Structure
Figure 2
RDO Regional Management Team
Regional Quality and Patient Safety Steering Committee (QPS)
Regional Governance Regional Serious Incident Regional Quality and Risk Groups Management Team Forum (RGG) (RSIMT) Capability development. Medical Devices, Monitoring of all serious Professional Support, Infection Control, PPPG, incidents notified to the Strategic implementation of Audit, HIQA prep., RDO Quality Improvement Medication Safety, etc programmes
Quality and Patient Safety Governance Structure
Regional Quality and Patient Safety Steering Committee The Committee is responsible for overseeing and coordinating quality and patient safety initiatives in the Region by ensuring that systems are in place to identify, evaluate and control the risks that threaten the achievement of the Region’s objectives and to provide assurance to the Regional Director of Operations with regard to the management of Quality and Patient Safety in the Region. The Committee has a paramount role in the promotion of quality improvement in seeking to improve service user care and outcomes. It is chaired by the Regional General Manager for Quality and Patient Safety and its membership includes the Area Managers (4), Clinical Directors (2), and a Director of Public Health Medicine.
Regional Serious Incident Management Team (RSIMT) This group oversees the management of all incidents escalated to the RDO. This team determines whether an issue that is escalated to the Office of the RDO can be managed by the RSIMT or whether it is of national significance and needs to be escalated to the National Incident Management Team in line with the HSE South Serious Incident Escalation Procedure and the HSE National Serious Incident Management Procedure. The Lead of this team is the Regional General Manager for Quality and Patient Safety and Chair of the Regional Quality and Patient Safety Steering Committee
Regional Governance Groups Each Care and Clinical specialist area is required to have in place a Regional Governance Group. This also includes groups with a particular interest, for example, Medical Devices, PPPGs, and Infection Control etc. The purpose of these governance groups will be to: . Monitor compliance regionally with standards and other regulatory requirements relevant to the clinical/care group/specialist area. . Review and quality assure reports arising from the review of serious incidents occurring in the clinical/care group/specialist area in the region and to identify learning that can be shared from these incidents. . To assist in the process of ensuring the best use of resources and the use of standardised processes relevant to the care/clinical group/specialist area. . Promote the use of a consistent approach to audit and other relevant quality tools within their care/clinical group/specialist area . To report to the Regional Quality and Patient Safety Steering Committee in an agreed manner
HSE South 15
QUALITY AND SAFE SERVICES
Regional Quality and Risk Forum Membership of this forum is made up of Quality and Risk practitioners from all service areas within the region. Its key purpose is to improve the capability of its members and to address the quality and risk agenda in a consistent manner across the region. It is therefore a forum for learning and development and also for planning a strategic approach to implementation of key quality and risk programmes, such as the implementation of the IHI Care Bundles.
Area Quality and Patient Safety Committees Each Area has a Quality and Patient Safety Committee, chaired by the Area Manager, and comprising of representatives from the hospital(s), Older Persons Services, Child and Family Services, Disability Services, Mental Health, Ambulance Services, Quality Manager, Risk Manager and Health and Safety Services. The Committee meets monthly and is responsible for overseeing and coordinating quality and patient safety initiatives in its own Area by ensuring that systems are in place to identify, evaluate and control the risks that threaten the achievement of the Area’s objectives and to provide assurance to the Regional Director of Operations (via the Regional Quality and Patient Safety Committee) with regard to the management of Quality and Patient Safety in each Area. The Committee has a paramount role in the promotion of quality improvement in seeking to improve service user care and outcomes.
Regional / Area Quality and Patient Safety Governance Structure
Figure 3 Regional Quality and Patient Safety (QPS) Committee
Carlow / Kilkenny Waterford / Kerry QPS Cork QPS QPS Committee Wexford Committee Committee QPS Committee
Hospital QPS Community Hospital QPS Community Hospital QPS Community Hospital QPS Community QPS QPS QPS QPS
Key Linkages for the Quality and Patient Safety Programme To facilitate a whole systems approach to the programme it will develop linkages with regional supports i.e. Performance and Development, Organisational Development and Design, Occupational Health and Safety, Ambulance Services, Primary Care and local specialist posts e.g. quality and risk, infection control, clinical engineering.
Key Result Areas Target Completion Key Result Area Deliverable Output 2012 Quarter Patient Safety Authority Support the development of the Patient Safety Authority through engagement with DoH Ongoing and HIQA National Clinical Effectiveness Support the ongoing work of the National Clinical Effectiveness Committee Ongoing Committee Clinical Governance Support the continuous development and implementation of Corporate Governance and Ongoing Accountability Frameworks for Clinical Governance and Patient Safety HSE South Multidisciplinary QPS committees established in each Area - monthly reports from each Area to Regional QPS committee by end of each Q1 month - active involvement of Clinical Directors on Area QPS committees Q2
HSE South 16 QUALITY AND SAFE SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter Implementing National Continue to progress the programme of change required to deliver compliance with these Ongoing Standards standards HSE South . 8 working groups established to identify gap analysis in preparation for National Standards for Better Safer Care (HIQA) - Identification of Structures and Processes already in place and those needed to Q1 be prioritised in region. - Identification of Outcomes to be measured to monitor readiness and compliance Q1 with National Standards (HIQA) - This will form a suite of metrics to be measured. - Measurement of theses Outcomes for analysis and to inform priorities for Quality Q3 and Patient Safety in the Region - Monthly reports from 8 Leads to Regional HIQA Preparation Governance Group Q1 . Patient Safety Culture Survey will be conducted across the Region in acute hospitals and community hospitals . Quality Assurance programme to ensure compliance with Ennis/Mallow General Q2 Reports - Regional Mallow Report Group Governance Group established 2011 Ongoing - Comprehensive survey sent to all acute hospitals in Q4 2011 Ongoing - Analysis of results of surveys Q1 - Site visits to all acute hospitals to verify results of survey Q1 Standards, Recommended Continue to support the development and implementation of standards, recommended Ongoing Practice and Guidance practice and guidance in key areas including: . Healthcare records management . Post Mortem Examination Services . Medical Devices and Equipment HSE South . Regional MDEMC established Q1 . Self Assessment against the MDEMC Standards Q1 . Quarterly reports to Regional QPS committee . Integrated Care . Medication Safety HSE South . Development of Regional Medication Safety Governance Group Q2 . Decontamination of Reusable Invasive Medical Devices HSE South . Regional Audit Committee to be established to focus on auditing of all internal self- Q2 assessments such as HSE Code of Practice of Decontamination of RIMD . Consent . National document development and approval process HSE South . Regional PPPG group to be established to identify, prioritise, support development Q2 of and sign off on HSE South Regional PPPGs . Training on development of PPPGs Ongoing Patient Radiation Protection Ensure patients are adequately protected from unnecessary harmful effects of ionising Ongoing Regulatory Requirements radiation through issuing of national guidelines, external clinical audit, monitoring of incidents, and liaising with other regulatory bodies Stakeholder Engagement Improve communications, engagement and working arrangements with all stakeholders Ongoing Advocacy and Service User Develop and implement best practice models of customer care, and service user Ongoing Involvement involvement throughout the HSE in line with National Strategy for Service User Involvement and Patient Charter of Rights and Responsibilities, You and Your Health Service HSE South . Collaborate with Regional General Manager, Consumer Affaires to implement Q4 Patient Charter of Rights and Responsibilities, You and Your Health Service as part of work undertaken for National Standards Preparation Theme 1 – Person Centred Care. . All regional committees will have a Service User representative Q4 Clinical Audit Implement Irish Audit of Surgical Mortality (IASM) Q4 Implement Irish National Orthopaedic Register (INOR) Q4 Quality and Patient Safety Continue to develop a structured programme of healthcare audits Ongoing HSE South 17
QUALITY AND SAFE SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter Audit Develop and support implementation of guidance for local clinical audit Q3 HSE South . Establish Regional Audit Governance Group to monitor, analyse and support Q2 recommendations arising from all Healthcare Audits conducted in the region. Integrated Risk Management Continue to implement the HSE Integrated Risk Management Policy with particular focus Ongoing on risk management, incident and complaints management HSE South . Area QPS committees to send bimonthly risk register reports to Regional QPS Q1 committee for assurance, analysis, audit and shared learning . Training on Risk Register development Ongoing . Monthly reports to Regional SIMT regarding incidents on the RDO and NIMT logs Ongoing . Incident Management training Ongoing Monitoring and Learning Progress the development of a comprehensive data collection, processes support, Ongoing analysis, and information system to enable the extraction of key learning from complaints, incidents, reports, and other sources for dissemination to services HSE South . Review monitoring arrangements currently available in region and link with 3 other Q2 regions to inform the development of a regional approach/system for monitoring. Develop and implement systematic processes for the ongoing learning across the system Q3 of the lessons learned from all reports, reviews, international experience and investigations into services HSE South . Regional Quality and Patient Safety website established in May 2010, alert system Ongoing for this website to highlight key lessons learned. . Communication Strategy on the website to be launched. Q1 . Provide education and training on Quality and Patient safety to staff Ongoing . Identify list of “mandatory” training Q2 . Support small scale local Quality Improvement Programmes Ongoing National Organ Donation and Ensure implementation of EU directive and oversee the quality and safety of donation Ongoing Transplantation Office and transplantation services in Ireland Healthcare Associated Improve hand hygiene by healthcare staff Ongoing Infections Ensure antimicrobials used appropriately (antimicrobial stewardship) Ongoing Prevent medical device related infections (such as IV lines and urinary catheters) Ongoing HSE South . Regional HCAI/AMR committee established in 2010. Q1 - Identification of gaps in key personnel to provide regional specialist advice - Quarterly reports on EARS-net Bloodstream Infection Hospital and Community; C-difficile surveillance, Hospital Hand Hygiene (Hand-gel consumption and reports from Lead Auditors), EARS-Net Enhanced Bacteraemia – these will be analysed and discussed at Regional HCAI/AMR meetings quarterly. . Care Bundles to prevent Catheter Associated Infections implemented in all HSE South Hospital ICUs Q4 . Care Bundles to prevent Ventilator Associated Pneumonia in the Tertiary Hospital ICUs Q4 Robust Intelligence Information Capture and provide robust intelligence information and evidence to support decision Ongoing and Evidence making through continued development of Health Atlas and other knowledge resources Continue to work with the DoH and the Health Technology Assessment (HTA) function of Ongoing HIQA to support robust HTA relevant to the clinical requirements of the HSE
HSE South 18
Promoting and Protecting Health
Introduction Promoting, protecting, and improving health and reducing health inequalities are key priorities for our organisation. To do this, it is essential to re-orientate our health services from a curative focus towards one of preventing ill health and promoting positive health. Evidence shows that the most effective practices are achieved through approaches that influence the determinants of health and health inequalities. These include ethnicity, race, gender, life style factors, education, socio-economic status, environment, and living conditions. Many diseases and premature deaths are preventable. Increased morbidity and mortality are strongly related to lifestyle health determinants such as smoking, alcohol consumption and drug consumption, physical inactivity, and obesity. There is, however, a clear relationship between socio-economic status and health behaviour: the higher an individual’s education, the healthier they are. In order to address this a key principle of improving health is working collaboratively, not just internally within the organisation, but externally with all our stakeholders including statutory and non-statutory bodies and the voluntary sector. Childhood vaccinations continue to be one of the most cost-effective public health interventions and, while we are showing significant improvements in uptake over the decade, we need to address particular areas, both geographically and socially, where uptake rates are not improving at the same level. Promoting and protecting the population’s health requires many interventions, which often occur when people are not ill or even aware of the intervention, or when we are supporting people to make healthy decisions. It also involves creating a healthier environment (green spaces for physical activity, safe food, hygienic facilities and a safe environment) where communities are supported to live healthy lives. Environmental health services play a key role in protecting the population through enforcement of legislation and the promotion of activities to assess, correct, control, and prevent those factors in the environment which can potentially adversely affect the health of the population. These include controls on food safety, tobacco, cosmetic products, pest control, poisons, etc. A lot of these activities along with the child health services are very dependent on the availability of community and public health staff, especially public health nurses, which is now severely depleted as a consequence of the restrictions on staff replacement.
The National Service Plan has identified the following priorities for 2012: Health Promotion . Implement the Health Promotion Strategic Framework within the three priority areas of education, community and health promoting health service. There will be specific targeting of tobacco, obesity, alcohol, breastfeeding and positive mental health. . Implement the recommendations of Your Health is Your Wealth: A Policy Framework for a Healthier Ireland 2012-2020, when finalised. . Establish evidence based interventions, which will ensure the priorities of promoting and protecting health are applied across and within clinical programmes. . Implement HSE Health Inequalities Framework 2010-2012. . Sustain the impact of the work of the Crisis Pregnancy Programme and work in partnership to co-ordinate sexual health promotion across the health service. Child Health Screening and Surveillance . Implement revised immunisation programmes such as Human Papilloma Virus (HPV). . Progress the National Immunisation Register. . Ensure a national approach to child health screening and surveillance. Health Protection . Focus on the control of measles, tuberculosis (TB) and sexually transmitted diseases. Emergency Management . Plan and prepare for major emergencies. Environmental Health . Reconfigure environmental health services nationally to ensure equity of service delivery. . Implement national protocols and Environmental Health Information System to ensure consistency of service delivery. . Continue to monitor and enforce existing and new environmental health functions including food, tobacco, international health, cosmetic product and pest control, poisons licensing, environmental impact assessment and waste licensing assessment, fluoridation and safety of drinking water supplies on behalf of HSE and external agencies.
HSE South 19 PROMOTING AND PROTECTING HEALTH
Tobacco Control . Implement the recommendations of the HSE Tobacco Control Framework and the Government’s strategy Towards a Tobacco Free Society: Report of the Tobacco Free Policy Review Group.
The budget reduction for the promoting and protecting health services in the South amounts to €0.127m which represents a 4.2% reduction.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Key Result Areas The following Key Performance Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Policy Framework for Implement recommendations of Your Health is Your Wealth: A Policy Framework for a Ongoing Public Health Healthier Ireland 2012-2020 in conjunction with other sectors, when finalised, and develop campaigns to support implementation Health Promotion Strategic Health Promotion Cross Setting Strategy and Policy Development Framework Expand community breastfeeding support Ongoing Prevent Overweight and Obesity Implement a Physical Activity Action Plan Ongoing
Review and standardise health promotion programmes in relation to obesity
Promote and advocate healthy weight management throughout the lifecycle
Develop a national system for surveillance and screening of children, according to Best Health for Children
Develop Adult Hospital Weight Management Treatment Services (1 per HSE area) and National Paediatric Hospital Service with the full multidisciplinary team in each centre to ensure the maximum throughput of patients with severe obesity Alcohol Develop and implement action plan based on relevant recommendations of the National Ongoing Substance Misuse Strategy, when published Tobacco Implement Tobacco Free Campus Ongoing Positive Mental Health Support mental health promotion priorities in partnership with mental health structures in Ongoing line with A Vision for Change Health Promoting Community Setting Develop and implement a model for health promoting communities Ongoing Develop community participation, community health needs assessment, and health equity audit within all services Support participating cities to establish new Irish Healthy Cities network Health Promoting Health Service Setting Develop and deliver to health care staff a national model for brief intervention training Ongoing (smoking, alcohol, diet, mental health) in partnership with other stakeholders Health Promoting Education Setting Implement nationally agreed model for health promoting schools Ongoing Development of health promoting tools and resources to support the development of the health promoting education setting Sexual Health Co-ordinate and standardise sexual health promotion activities and agree regional sexual Ongoing health promotion plans Crisis Pregnancy Fulfil all statutory requirements relating to crisis pregnancy prevention and crisis pregnancy Ongoing support, and implement a strategic plan in line with legislative requirements
HSE South 20
PROMOTING AND PROTECTING HEALTH
Target Completion Key Result Area Deliverable Output 2012 Quarter Ensure strategic plan is fully aligned across related HSE programmes and agree regional implementation plans Develop a plan to ensure that prevention activity led by the Crisis Pregnancy Programme is co-ordinated with other sexual health education and promotion activity in order to add value to work in this area Health Inequalities Develop health inequalities related tools and resources Q3 Develop key performance indicators and measures to inform planning Q2 National Immunisation, National Immunisation Infectious Diseases and Develop a national immunisation registry for all immunisations Ongoing Child Health Deliver a National Immunisation Programme, with vaccine uptake rates in accordance with international targets Implement a measles elimination plan, with MMR catch-up programme Implement a national standardised school based immunisation programme Q3 Increase influenza vaccination uptake rates in General Medical Services (GMS) and doctor Ongoing only card holders aged 65 years and older Improve uptake of influenza vaccine among healthcare workers Improve prevention, control, and management of infectious diseases: Implement tuberculosis (TB) guidance 2010 Ongoing Develop (Q3) and implement TB Action Plan which reflects the World Health Organisation (WHO) consolidated Action Plan to combat TB Develop (Q3) and implement a plan to reduce sexually transmitted illnesses and improve sexual health Reduce the impact of vaccine preventable diseases Implement requirements of the International Health Regulations Child Health Reach agreement on revised child health model programme and develop change plan Q2 Review Best Health for Children guidelines and develop implementation plan including Ongoing review of training needs Progressively implement governance structure for all non-cancer childhood national Q1 screening programmes Develop a Child Injury Prevention plan Q2 Review and update Child Health Information Service Project (CHISP) documents and Child Q1 Health website for parents / practitioners Emergency Management Maintain and develop policies, standards and guidance in emergency management, Ongoing ensuring an effective response to all major emergencies Further develop national and regional interagency plans and procedures in emergency management with other response agencies and governmental departments Environmental Health Reconfigure environmental health services nationally to ensure equity of service delivery Ongoing Implement national protocols for environmental health service activities to ensure Q1 consistency Implement National Environmental Health Information system for all service users Ongoing throughout the country, providing evidence base for health protection decisions Target activities of tobacco control enforcement on areas of least compliance (complaints, under age sales to minors, and smoke free exempted areas) Implement annual work plan under the service contract with the Food Safety Authority of Ireland Participate in the European pilot study (Democophes) on human bio-monitoring Q2 Set up a high level advisory group to provide technical and academic oversight of any Q3 future proposed bio-monitoring studies (including fluoride intake) in Ireland Complete compliance building and training for the introduction of sunbed legislation Q2 nationally to reduce risk of exposure to children Implement the obligatory requirements of the International Health Regulations (IHR) Q2 including standardising the inspection of designated airports and seaports for compliance with IHR core capacities and continued involvement in the ship sanitation (SHIPSAN) project Implement National Standards for Pre-School Services, in conjunction with Children and Ongoing Family Services Agree Memorandums of Understanding / Service Level Agreement with Environmental Protection Agency, Irish Medicines Board, and Children and Families Services
HSE South 21
PROMOTING AND PROTECTING HEALTH
Target Completion Key Result Area Deliverable Output 2012 Quarter Tobacco Control Tobacco Control Framework Review smoking cessation services, develop and roll out standardised national model to Q3 include national database Deliver standardised training in brief intervention for smoking cessation to 3,521 frontline Ongoing healthcare workers, prioritising settings going tobacco free in 2012: . DNE 1,083 . DML 542 . South 813 . West 1,083 Continue national roll out of tobacco free campus policy: . DNE – five hospitals, all newly opened primary care sites, all administration sites . DML – two hospitals, all newly opened primary care sites, all administration sites . South – two hospitals, all newly opened primary care sites, all administration sites . West – four hospitals, all newly opened primary care sites, all administration sites Develop and implement a national policy to protect staff from second-hand smoke Q2 exposure while working in domestic settings Develop and implement a national policy to protect children in care from tobacco exposure Ongoing
Maintain social marketing QUIT campaign Ongoing Continue to monitor and evaluate the effectiveness of tobacco control measures Maintain tobacco legislation enforcement HSE National Tobacco Control Office Implement recommendations of Towards a Tobacco Free Society: Report of the Tobacco Ongoing Free Policy Review Group and the Tobacco Control Framework Support the implementation of the DoH’s Tobacco Policy Review Group recommendations (when finalised) Fulfil statutory obligations under Tobacco legislation
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 Total South South Immunisations and Vaccines % children (aged 12 months) who have received 3 doses 95% (National) 89% 95% (National) Diphtheria (D3), Pertussis (P3), Tetanus (T3) vaccine Haemophilus influenzae type b (Hib3) Polio (Polio3) hepatitis B (HepB3) (6 in 1) % children at 12 months of age who have received two doses of 95% (National) 87% 95% (National) the Pneumococcal Conjugate vaccine (PCV2) % children at 12 months of age who have received two doses of 95% (National) 87% 95% (National) the Meningococcal group C vaccine (MenC2) % children (aged 24 months) who have received 3 doses 95% (National) 95% 95% (National) Diphtheria (D3), Pertussis (P3), Tetanus (T3) vaccine, Haemophilus influenzae type b (Hib3), Polio (Polio3), hepatitis B (HepB3) (6 in 1) % children (aged 24 months) who have received 3 dose 95% (National) 95% (National) 95% (National) Meningococcal C (MenC3) vaccine % children (aged 24 months) who have received 1 dose New PI 2012 New PI 2012 95% (National) Haemophilus influenzae type B (Hib) vaccine % children (aged 24 months) who have received 3 doses New PI 2012 New PI 2012 95% (National) Pneumococcal Conjugate (PCV3) vaccine % children (aged 24 months) who have received the Measles, 95% (National) 91% 95% (National) Mumps, Rubella (MMR) vaccine % children (aged 4-5 years) who have received 1 dose 4-in-1 New PI 2012 New PI 2012 95% (National) vaccine (Diphtheria, Tetanus, Polio, Pertussis) % children (aged 4-5 years) who have received 1 dose Measles, New PI 2012 New PI 2012 95% (National) Mumps, Rubella (MMR) vaccine HSE South 22
PROMOTING AND PROTECTING HEALTH
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 Total South South % children (aged 11-14 years) who have received 1 dose New PI 2012 New PI 2012 95% (National) Tetanus, low dose Diphtheria, Accelular Pertussis (Tdap) vaccine No. and % of first year girls who have received third dose of New PI 2012 New PI 2012 New PI 2012 HPV vaccine by August 2012 80% (National) No. and % of sixth year girls who have received third dose of New PI 2012 New PI 2012 New PI 2012 HPV vaccine by August 2012 80% (National) Child Health / Developmental Screening % of newborns who have had newborn bloodspot screening New PI 2012 New PI 2012 100% (National) (NBS) % newborn babies visited by a PHN within 48 hours of hospital 95% (National) 87% 95% discharge
% of children reaching 10 months within the reporting period 90% (National 88% 95% (National) who have had their child development health screening on time before reaching 10 months of age Tobacco Control No. of sales to minors test purchases carried out 80 (National) 292 (National) 216 (National) No. of offices, per region, carrying out sales to minors test 2 per region 13 (National) 2 purchase activities per region (different offices) No. and % HSE hospital campuses with tobacco-free policy New PI 2012 New PI 2012 3 No. of frontline staff trained in brief intervention smoking New PI 2012 New PI 2012 813 cessation across primary care and acute campuses Food Safety % of Category 1, 2 food businesses receiving inspection target 100% (National) 92% (National) 100% (National) as per FSAI Guidance Note Number 1 Cosmetic Product Safety No. of cosmetic product inspections New PI 2012 New PI 2012 750 (National) International Health Regulations All designated ports and airports to receive an inspection to 8 (National) 8 (National) audit compliance with the IHR 2005 8 (National) Health Inequalities No. of hospitals implementing a structured programme to New PI 2012 New PI 2012 5 (National) address health inequalities (as outlined in the HSE Health Inequalities Framework and specified in this metric) No. of PCTs implementing a structured programme to address New PI 2012 New PI 2012 10 (National) health inequalities (as outlined in the HSE Health Inequalities Framework and specified in this metric)
HSE South 23
Primary Care Services, Community (Demand-Led) Schemes and other Community Services
Resources Introduction FINANCE – HSE SOUTH Our vision for primary care is that the health of the population will be managed, as far as possible, within a primary care setting, with the 2011 2012 population very rarely requiring admission to a hospital. Those with additional Area Budget Budget or complex needs will have plans of care developed with the local Primary €m €m Care Team (PCT) who will co-ordinate all care required with specialist Cork 61.956 58.858 services in the community and, for hospital attendance, through integrated Kerry 11.739 11.162 care pathways. The PCT will act as the central point and will actively engage Carlow /Kilkenny/Sth Tipp 30.464 28.962 on the medical and social needs of its defined population with a wider Health Waterford/Wexford 16.858 16.017 and Social Care Network (HSCN). The HSCN covers a number of PCTs and Total 121.017 114.999 provides specialist and care group services such as dietetics, ophthalmology, audiology, podiatry, etc. WTE Ceiling – HSE SOUTH Implementation of a programmatic approach to improving care will ensure Dec 2011 Projected Area that primary care and acute services are provided in a systematic way, Dec 2012 improving outcomes for patients in terms of patient care, health status, and Cork 893 865 reduced waiting lists, while saving money. Kerry 221 214 In line with the commitment in the Programme for Government to a Carlow /Kilkenny/Sth 445 431 significant strengthening of primary care services, additional funding of €20m Tipp is being allocated to fill as many vacancies as possible and to expand Waterford/Wexford 378 366 existing arrangements where sessional services are provided by allied health Total 1,937 1,876 professionals. This will be increased to €25m if it can be established that there is scope for further savings of €5m in demand-led schemes. The allocation of the extra posts will be subject to approval by the joint DoH / HSE project team overseeing the implementation of Universal Primary Care. The challenging and restricting reducing financial environment impacts on all aspects of primary care services, PCT delivery, PCT and HSCN development and should not be underestimated. This new investment will help to mitigate some of the impact of the loss of staff and service delivery through PCTs and HSCNs. The Primary Care Reimbursement Service (PCRS) provides a wide range of primary care services across 12 community health schemes to the general public, through 6,500 primary care contractors (1,746 in primary care contractors in HSE South). These contractors include General Practitioners, Pharmacists, Dentists and Optometrists / Ophthalmologists. This service provision forms the infrastructure through which the Irish health system delivers a significant proportion of primary care to the public. The infrastructure, both from a human resource and e-business technology perspective, supports the provision of a flexible and client focused service. The standard operating model and business processes enable us to deliver value for money for health resources. The national budget requires the achievement of cost management totalling €124m in 2012 (€6.018m in HSE South). These required reductions are building on the €414m reductions applied in 2011. Delivery of this challenging cost saving target is dependent upon the implementation of legislative changes in relation to reference pricing and new agreements with pharmaceutical manufacturers. Efficiencies in prescribing will be targeted along with delisting in order to facilitate the introduction of new drugs. Priorities for 2012 will be progressed in the context of a challenging macroeconomic environment coupled with dynamic socio-economic and demographic trends.
The National Service Plan priorities for 2012 within available resources are to ensure that the delivery of health services, for the most part, will occur in a primary care setting, with patients very rarely requiring admission to hospital services: PCTs and HSCNs . Respond to the episodic care needs of the population through PCTs and HSCNs and develop primary care services by improving access to services through PCTs and further developing HSCNs. Chronic Disease . Commence plans for the management of chronic disease in primary care in a number of areas including stroke, heart failure, asthma, diabetes, chronic obstructive pulmonary disease, dermatology / rheumatology and care of the elderly. . Develop an overall chronic disease watch model of care with initial focus in 2012 on the diabetes programme. GP and Community Initiatives . Maximise opportunities to develop Community Intervention Teams (CITs). . Implement national programmes through PCTs.
HSE South 24 PRIMARY CARE, DLS AND OTHER COMMUNITY SERVICES
. Participate with the DoH in the development of a new general practitioner (GP) contract to meet emerging service requirements. . Implement recommendations of the National Review of GP Out of Hours Services. ICT Infrastructure . Develop ICT electronic referrals systems within and from primary care to the acute sector. Service User Involvement . Implement agreed national framework for service user involvement in PCTs. Oral and Audiology . Implement strategic reviews on both dental and oral health services. . Implement recommendations from the review of audiology services. Universal Health Insurance and Eligibility . Work with the DoH, who has the lead role in this priority, towards phased introduction of Universal Health Insurance (UHI) as required.
The National Service Plan has identified the following priorities for 2012 for Community (Demand-Led) Schemes: . Continue to provide a wide range of primary care services to the general public across 12 community health schemes through our 6,500 primary care contractors (1,746 in HSE South). . Advance the process of transforming primary care services provided by GPs by working with them to ensure their service arrangements support health service provision reorganisation. . Harness community pharmacy expertise to build capacity in primary care, optimise medicines usage in the community, encourage self care as appropriate and to provide lifestyle advice to enable people to keep active and well for as long as possible. . Support the DoH to progress the development of new contracts with GPs and community pharmacists, which clearly define and articulate the core professional services to be provided by them within a standards based framework. . Progress a number of key strategic projects with the objective of continuously enhancing primary care services during 2012 through for instance promoting electronic referrals within and from primary care to the acute services and further roll out of the Newborn Hearing Screening Programme.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Service Quantum In 2012 we will: . Provide 134 Primary Care Teams (PCTs) - including 23 new PCTs to be developed in 2012
Actual No. of Target No. PCTs Target No. PCTs full LHO PCTs in operation in Operation rollout Y/E 2011 Y/E 2012 Y/E 2012 Carlow / Kilkenny 14 16 2 Kerry 9 16 7 North Cork 8 12 4 North Lee 21 21 0 South Lee 19 22 3 South Tipperary 7 10 3 Waterford 9 12 3 West Cork 8 8 0 Wexford 16 17 1 TOTAL 111 134 23
. Reorganise services within the 36 Health and Social Care Networks necessary to support the PCTs in the provision of community based services and care groups. This will include services such as mental health and child protection amongst others.
HSE South 25
PRIMARY CARE, DLS AND OTHER COMMUNITY SERVICES
. Further develop services within the five Primary Care Centres opened in 2011 in Ayrefield, Kilkenny; Callan, Kilkenny and Tramore; Carlow Primary Care / Medical Centre; Blackrock Hall, Cork . Opening four new Primary Care Centres in Macroom, Gorey (2), Schull and Kenmare. . Develop the following Primary Care Centres through the PPP - these are at various stages of development and will be progressed during 2012/2013
Location No. of PCT’s Current Status Cork Cobh 1 Agreement for Lease signed Completion Q1 2014 Newmarket 1 Agreement for Lease signed Completion Q1 2014 Togher inc. Greenmount /The Lough 3 City council to offer site for sale inc PCC site Fermoy 2 Negotiations ongoing Mayfield 1 Discussions ongoing Charleville 1 Agreement for Lease signed Completion Q1 2014 Schull 1 To commence construction shortly Ballineen 1 Proposal subject to HSE approval Carrigaline 2-3 Proposal subject to HSE approval Kerry Listowel 2 Agreement for lease signed completion Q1 2013 Caherciveen 1 Progressing subject to legal and agreement on plans Carlow/Kilkenny South Tipperary Tipperary Town 1 Agreement for lease signed Completion Q1 2014 Kilkenny City (2) 1 Negotiations ongoing Thomastown 1 Agreement for lease signed. Waterford/Wexford Enniscorthy 1 Negotiations ongoing New Ross 1 Bid process ongoing
. In association with Caredoc and Southdoc, further develop Community Intervention Teams (CITs) in Carlow/Kilkenny and Cork City and establish CITs in Waterford and Kerry. . Continue health promotion through the Primary Care Teams in schools, the workplace and the community . Undertake a local health needs assessment to inform and influence service developments as we develop each primary care team
Cost Management & Employment Control Measures The budget reduction for primary care services in the South amounts to €5.960m which represents a 5% reduction in 2012 budget. The range and quantum of services to be provided in 2012 (as outlined above) takes account of the reduction in 2012 budget. The cost management measures necessitated by the reduced funding available for primary care services in 2012 are summarised below. Every effort is made to ensure that the impact on services is minimised. . Reduction in funding to the GP co-operatives – Caredoc and Southdoc in line with the relevant recommendations of the national GP Out of Hours Review. Savings to be achieved without reduction in the quantum of service provided to patients.
Service Improvements . Development of Community Infusion Unit at Ayrfield Primary Care Centre, Kilkenny - joint initiative between St Luke's Hospital and Primary Care Team and Community Services. . Research Project on Efficacy of Primary Care Teams to be undertaken in North Cork. . In line with national developments and in relation to the Diabetic Chronic Disease Management Programme, work towards establishing a new specialist multidisciplinary paediatric diabetic centre in Cork. . The existing Primary Care Diabetes Initiatives will develop in line with the National Diabetes Programme to consolidate and expand existing Primary Care Diabetes Initiatives and the discharge of Type 2 Diabetes patients from the hospital serving those Primary Care Diabetes Initiatives by Q4.
Improving our Infrastructure
Location Development Operational Date Gorey (2) Primary Care Centre - By lease agreement Q2 2012 Schull Primary Care Centre - By lease agreement Q 4 2012 Kenmare Primary Care Centre - By lease agreement Q2 2012 Macroom Primary Care Centre - By lease agreement Q1 2012
HSE South 26
PRIMARY CARE, DLS AND OTHER COMMUNITY SERVICES
Key Result Areas The following Key Performance Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Primary Care Teams and Health Commence phased roll out of chronic disease management for diabetes Q4 and Social Care Networks Increase access to primary care services through 489 PCTs Q3 HSE South: . 134 PCTs in HSE South (23 to be developed in 2012) Q3 Enhance service integration through development of HSCNs, this being enabled Q4 through reconfiguration of existing resources Develop clinical leadership and implement clinical governance and service Q3 management for PCTs Continue to develop ICT electronic referrals systems within and from primary care to Q4 the acute sector (pilots in HSE South and Tallaght) Multidisciplinary Complex Care Improve direct access to childcare and disability services, and community mental Q3 health services through PCTs Develop protocols signposting referral pathways between specialist addiction / Q3 homeless / traveller services and primary care services Enhance Primary Care Services Maximise opportunities to develop Community Intervention Teams (CIT) Expand services in existing six CITs within primary care settings Ongoing HSE South Expand services in Carlow/Kilkenny and Cork CITs and, in association with Caredoc Q3 and Southdoc, develop Community Intervention Teams in Waterford and Kerry. Implement National Programmes through PCTs Deliver Community Cancer Control Programmes through PCTs including: Ongoing . Promulgation of training for practice nurses and public health nurses . Development of e-learning programmes in prevention, early detection and cancer care for GPs and for community nurses . Delivery of GP information and training sessions in association with the ICGP and GP Continuing Medical Education (CME) networks . Further implementation of electronic referral processes via GP software systems to have 20% of cancer referrals made electronically (i.e. for those specialties where electronic referral processes have been developed – breast, prostate and lung) . Development of a standardised approach to brief intervention training in smoking cessation for all health care professionals Falls Prevention Deliver falls prevention programmes through PCTs Ongoing Accommodation Sufficient and appropriate accommodation available to enable successful functioning of PCTs Open 19 additional primary care centres accommodating 27 PCTs Ongoing HSE South . Open 4 additional primary care centres in Schull, Gorey (2), Macroom and Kenmare GP Training Conclude the transfer of the GP Training Scheme to the ICGP as contracted service Q3 providers New GP Contract Participate in the development of new GP contract to meet emerging service Ongoing requirements (led by DoH) Audiology Services Improve Audiology Services Progress Implementation of Recommendations from National Review of Audiology Services to include: Restructure services into integrated audiology service, and recruit national clinical Ongoing lead and other key clinical support posts HSE South . Support the restructuring of services into integrated audiology service, establish developments initially within Cork /Kerry ISA Further roll out Newborn Hearing Screening Programme to include clinical education, infrastructure and equipping requirements Progress consultation and negotiation of workforce planning recommendations including MSc Sponsorship Programme requirements Progress Audiology IT / Patient Management System HSE South 27
PRIMARY CARE, DLS AND OTHER COMMUNITY SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter Roll out of Bone Anchored Hearing Aid Programme (BAHA) Oral Health Implement Independent Strategic Review of the Delivery and Management of HSE Ongoing Dental Services Establish standards for eligible and most vulnerable patients under the Dental Treatment Services Scheme Reduce urgent dental general anaesthesia waiting lists for adults with intellectual disabilities Commence implementation of Phase 1 HIQA Infection Control Standards for Dental Services Reconfigure primary care dental services Q1 Enhancing Primary Care Provide a wide range of primary care services to the general public across 12 communi Q4 Reimbursement Services health schemes through our 6,500 primary care contractors. Oncology Centralise the reimbursement of oncology drugs by utilising the existing business Q1 expertise and IT infrastructure of PCRS Hi Tech Drugs Scheme Centralise the reimbursement of the High Technology Drugs Scheme (HTDS) Q4 commencing initially with rheumatology by utilising the existing business expertise and IT infrastructure of the PCRS National Client Index Implement a National Client Index to support delivery of a wide range of potential Q4 benefits across the health system (such as the National Integrated Patient Management System (IPMS) and the National Integrated Medical Imaging System (NIMIS) Strategic Review of Pharmaceutical Value Chain Complete a strategic review of the pharmaceutical value chain from manufacturer to Q1 client to ensure the optimum business model is applied to deliver value for money Prescribing Feedback Initiative Develop and implement proposals to influence prescriber behaviour with GPs having Q4 access to online analysis of their individual prescribing GP Out of Hours Review Implement recommendations from National Review of GP Out of Hours Services Q4 Validate payments to GPs who are members of out of hour co-ops by reference to Q4 claims recorded on the co-op system, with submission to PCRS via agreed processes using specified electronic files Dental Review Implement recommendations of Dental Treatment Services Scheme (DTSS) review Q4 Centralisation of Primary Care Schemes Continue to ensure centralisation of primary care schemes in collaboration with the Q4 regions and continue to work through current charging processes to facilitate implementation of new national and local billing arrangements Probity Programme Continue to deliver upon the probity programme for schemes to ensure that Q4 expenditure under the schemes is appropriate in accordance with the terms and conditions under which funding is approved and the facts upon which payments to claimants are verified Continue to improve e-commerce infrastructure, driving further efficiencies in day to Q4 day business operations Continue to leverage opportunities to deliver more efficient and effective medical card Q4 processing following centralisation Apply a clinical focus to all licensed drugs / medicines reimbursed for appropriateness Q4 Rationalise all licensed drugs / medicines reimbursed based on need Q4 Govern reimbursement decisions of all New Chemical Entities (NCE) where there is a Q4 budget impact. Continue to review all non-drug items reimbursed under schemes for appropriateness Q4 Long Term Illness Scheme Extend free GP care to LTI claimants (provision of additional €15m for 2012) Ongoing
HSE South 28
PRIMARY CARE, DLS AND OTHER COMMUNITY SERVICES
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South Primary Care New PI for 2012 New PI for 2012 Dependent upon timing of No. of PCTs implementing structured GP Chronic Disease commencement of Management for Diabetes to incorporate the structured management programme of chronic diseases within this cohort of patients No. of Health and Social Care Networks in operation New PI for 2012 New PI for 2012 14
No. of Health and Social Care Networks in development New PI for 2012 New PI for 2012 22
% of Operational Areas with community representation for PCT and New PI for 2012 New PI for 2012 17 Network Development 100% (National) GP Out of Hours No. of contacts with GP out of hours 437,537 412,265 412,265 Physiotherapy Referral No. of patients for whom a primary care physiotherapy referral was New PI for 2012 New PI for 2012 48,648 received in the reporting month
Health Care Associated Infection: Antibiotic Consumption Consumption of antibiotics in community settings (defined daily doses
per 1,000 inhabitants per day) New PI for 2012 21.7 21 (National) (Q2 data) (National) Orthodontics No. of patients receiving active treatment during reporting period 18,000 (National) 3,024 3,024 No. of patients in retention during reporting period To be disaggregated in 2011 958 958 No. of patients who have been discharged with completed orthodontic 2,000 (National) 365 365 treatment during reporting period
Community (Demand-Led) Schemes
Performance Activity Expected Activity 2011 Projected Outturn 2011 Expected Activity 2012 National National National Medical and GP Visit Cards No. persons covered by Medical Cards 1,779,585 1,733,126 1,838,126 (Incl. no. persons covered by discretionary Medical Cards) 80,502 76,644 85,000 No. persons covered by GP Visit Cards 138,816 132,097 204,482 (Incl. no. persons covered by discretionary GP Visit Cards) 17,423 16,904 20,000 Long Term Illness No. of claims 978,111 825,255 844,241 No. of items 3,178,861 2,731,595 2,794,437 Drug Payment Scheme No. of claims 3,836,264 3,187,303 2,726,939 No. of items 11,355,342 9,880,639 8,453,510 GMS No. prescriptions 20,364,442 20,336,688 22,154,661 No. of items 63,076,913 57,146,092 61,589,957 No. of claims – Special items of Service 740,274 863,736 859,123 No. of claims – Special Type Consultations 1,098,668 1,108,649 1,074,340 HiTech No. of claims 435,345 428,994 452,267 DTSS No. of treatments (above the line) 968,784 961,500 1,164,805 No. of treatments (below the line) 53,916 41,989 50,867 No. of patients who have received treatment (above the line) New PI 2011 --- To be reported during 2012
HSE South 29
PRIMARY CARE, DLS AND OTHER COMMUNITY SERVICES
Performance Activity Expected Activity 2011 Projected Outturn 2011 Expected Activity 2012 National National National No. of patients who have received treatment (below the line) New PI 2011 --- To be reported during 2012 Community Ophthalmic Scheme No. of treatments 715,455 708,862 739,579 i). Adult 652,186 648,889 677,007 ii). Children 63,269 59,973 62,572
Performance Expected Target 2011 Projected Outturn 2011 Expected Target 2012 Indicators National National National Medical Cards ------% of Medical Cards processed which are issued within 15 90% working days of complete application Median time between date of complete application and issuing of ------Baseline to be set in 2012 Medical Card (for reporting from Q2) GP Visit Cards ------% of GP Visit cards processed which are issued within 15 working 90% days of complete application Median time between date of complete application and issuing of ------Baseline to be set in 2012 GP Visit Card (for reporting from Q2)
HSE South 30
Hospital Services
Introduction Resources Acute hospitals deliver, on a regional, supra-regional or national basis, a wide range of services for acute, complex and non-urgent conditions. Over FINANCE – HSE SOUTH the last number of years, we have been restructuring the way in which we 2011 2012 provide these services both in terms of how, and where, they are delivered. Area Budget Budget Hospital budgets are under considerable pressure as demand for services €m €m continues to grow year on year and, based on traditional ways of service Cork 402.806 372.683 provision, is outstripping service capacity within our current system. The Kerry 71.319 65.162 priority in 2012 will be to stabilise the level of services that can be provided Carlow /Kilkenny/Sth Tipp 101.224 94.019 for the available resource and to continue the work of our change Waterford/Wexford 186.589 174.211 programme. The cornerstone of the change programme are the national Total 761.938 706.075 clinical programmes of care and the rationalisation of services to ensure that best use is made of each hospital site. In 2012 we are committed to WTE Ceiling – HSE SOUTH continuing to reorganise our hospital resources to ensure patients receive the Dec 2011 Projected best possible outcomes. Area Dec 2012
The national clinical programmes of care provide a national, strategic and co- Cork 5,414 5,222 ordinated approach to a wide range of clinical services. The primary aim of Kerry 939 915 these is to modernise the manner in which hospital services are provided Carlow /Kilkenny/Sth Tipp 1,567 1,521 across a wide range of clinical areas through the standardisation of access Waterford/Wexford 2,517 2,454 to, and delivery of, high quality, safe and efficient hospital services, Total 10,437 10,112 maximising linkages to primary care and other community services.
We will also continue to focus on improving timely and equitable access to services and will work with the DoH’s Special Delivery Unit (SDU) to improve waiting times for emergency services and scheduled / planned care.
Monitoring and Measuring Acute Hospital Performance 2012 The 2012 Performance Scorecard is the National Scorecard by which performance is assessed against the three criteria of quality, access and resources.
In the HSE South performance will be monitored under those 3 criteria with a specific focus on the following activity targets set by the SDU
Unscheduled care . Ensure that 95% of all attendees at EDs are discharged or admitted within 6 hours of registration, and that those who need to be admitted through ED wait no more than 9 hours from registration. . An average length of stay (ALOS) of 5.8 days or less . A reduction in bed days lost through delayed discharges
Scheduled care . Ensure that nobody is waiting more than 9 months for planned surgery . Ensure that nobody is waiting more than 20 weeks for paediatric elective inpatient or day case surgery . Ensure that nobody is waiting more than 4 weeks for an urgent colonoscopy . Ensure that nobody is waiting more than 13 weeks for routine GI endoscopy (colonoscopy/gastroscopy)
The focus of SDU is to ensure long term sustainability to the ongoing service improvements and to be satisfied that there is a sufficient degree of flexibility across unscheduled and scheduled care service delivery in the region.
In addition to the specific targets set out above, the region is committed to working with the SDU in relation to delivering on the priorities set by the Minister for Health and ensuring that integrated plans addressing the balance of capacity, demand, resources and associated risks across the region are in place during the implementation of any changes to how services are delivered. Specifically; service reorganisation, cost containment plans and ongoing financial monitoring, implementation of the “Framework for Smaller Hospitals” and the impact of staff retirements.
HSE South 31 HOSPITAL SERVICES
The acute hospital services in HSE South are delivered across a number of sites including:
South West Acute Hospital Network: Cork Area . Cork University Hospital Group - comprising Cork University Hospital (CUH), Cork University Maternity Hospital (CUMH), Mallow General Hospital (MGH) . Bantry General Hospital (BGH) . 2 Voluntary Hospitals in Cork City also provide Public Acute Hospital Services, namely: o Mercy University Hospital (MUH); o South Infirmary/Victoria University Hospital (SIVUH). Kerry Area . Kerry General Hospital (KGH)
South East Acute Hospital Network: Carlow / Kilkenny & South Tipperary Area . South Tipperary General Hospital (STGH), . St. Luke’s General Hospital including Kilcreene Orthopaedic Hospital (SLGH) Waterford / Wexford Area . Waterford Regional Hospital (WRH) . Wexford General Hospital (WGH)
The National Service Plan has identified the following priorities for 2012: . Reform acute services to ensure we achieve best patient outcomes, including continuing to change the roles of many of our hospitals. . Implement standardised national clinical programmes which will ensure generic models of care and efficient service delivery solutions. These will deliver improvements in the delivery, quality and patient safety of services. . Planned Care - Treatment of patients in chronological order for both inpatient and day case to achieve the PTL targets. The exceptions being clinical urgency and cancer patients . For All Care To deliver 7 day early morning ward rounds by a senior decision maker achieving a significant increase of weekend discharges and a balanced distribution of discharges by day of week. To deliver full implementation of the estimated date of discharge (EDD) process for each patient linked to an explicit treatment plan and best practice. To meet all the targets for unscheduled care. To deliver on all KPI’s on the Balanced Scorecard of Quality, Access and Finance. To meet the deliverables and schedules of the Clinical Care Programmes as defined explicitly by the programmes. . Commence implementation of a national model for paediatric care. . Change the way we resource hospitals in order to maintain service levels and drive improvement efficiencies such as funding certain elective orthopaedic procedures in selected hospitals on a cost per procedure (DRG) basis. . Strengthen hospital management to improve accountability for hospital service and budgetary performance. . Reorganise pre-hospital emergency care services to respond to changing models of service within available resources.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Cost Management & Employment Control Measures The budget reduction for Acute services in the South which is service impacting amounts to €28m. This represents a reduction of (3.76%). In addition the underlying deficits and service pressures from 2011 which will need to be addressed in 2012 amounts €26.411m (3.54%). There are 214 staff WTE (2%) who will leave the service as a result of the grace period 2012. To address the funding issues and reduction in staff numbers a range of measures are being implemented for Acute services in 2012 are summarised below:
In 2012, the approach in the first instance to cost containment will be to reduce inpatient treatment while maintaining day case procedures in line with the targets set in the National Service Plan. We will be using the HSE South 32
HOSPITAL SERVICES
National Clinical Programmes, in particular around acute medicine, emergency department and surgery to enable the hospital service to maximise activity while reducing overall cost and headcount. However, given the scale of the resource reduction in terms of finance and staff numbers, it will be necessary to reduce our capacity (clinics / theatre sessions / beds etc.) and overall activity levels within the hospital system while minimising the impact on patients and clients. The HR strategy deployed within the acute hospital service will seek to ensure that staff resources are allocated to the areas of greatest priority utilising the Public Service Agreement to support our change programme. We will focus on maximising the reorganisation of rostering, reduction in overtime and agency, and increasing skill mix and other measures to limit impact on frontline services and the overall patient experience.
2012 Resource Challenge - Acute Hospitals
Total 2012 Hospital Budget 2011 Incoming Deficit Budget Cut 2012 Resource Challenge €m €m €m €m CUH Group 270.995 9.139 9.793 18.932 MUH 56.379 2.035 2.365 4.400 S. Vic 46.268 1.871 1.894 3.765 BGH 16.975 0.340 0.566 0.906 WRH 135.465 8.497 5.090 13.587 WGH/ Ely 47.772 0.433 1.895 2.328 SLK/ Kilcreene 55.728 1.478 2.183 3.661 STGH 45.604 1.118 1.772 2.890 KGH 71.319 1.500 2.477 3.977 HSE South 746.505 26.411 28.035 54.446
Service Quantum In partnership with all key stakeholders, a range of inpatient, outpatient and day case services are provided by 12 acute hospitals in HSE South to a population in excess of 1.14m and to a broader population for certain specialist services. Services are delivered in accordance with the principles of equity, people centredness, quality and accountability.
2012 Projected Activity Inpatient Day Case Combined South Region Targets 138,958 161,970 300,928 Cork University Hospital 26,696 55,297 81,993 Cork University Maternity Hospital 13,740 5,360 19,100 Mallow General Hospital 2,956 3,500 6,456 Bantry General Hospital 1,889 1,725 3,614 Mercy Hospital 8,684 19,324 28,008 South Infirmary - Victoria Hospital 7,985 18,069 26,054 Kerry General 13,936 9,843 23,779 Waterford Regional Hospital 22,237 19,564 41,801 South Tipperary General Hospital 11,561 7,523 19,084 Wexford General Hospital 14,890 9,300 24,190 St Luke's Hospital - Kilkenny 13,487 11,545 25,032 Orthopaedic Hospital - Kilcreene 897 920 1,817
2011 outturn indicates that we delivered more inpatient activity than planned with hospitals running 3.9% over their 2011 target level. At the same time, the 2011 outturn for daycase indicates that hospitals in the south delivered less activity than planned with 1.5% under our target. The focus for 2012 will be to reverse this trend by reducing inpatient activity but seeking to increase our daycase activity moving far closer to the national target of 75%. Each hospital will target improving their performance on procedures on day of admission as well as the daycase rate for the agreed basket of surgical procedures to the national target of 75%. The specific deliverables for each hospital are outlined in the relevant sections of this document,
National Clinical Programmes, Service Development & Reorganisation A fundamental challenge for the two hospital networks in HSE South in 2012 is to fastrack implementation of the National Clinical Programmes and SDU initiatives to mitigate the impact of the resource challenge around reduced budgets and staff numbers this year. In implementing these programmes we will look to new and innovative ways of using a reducing resource while challenging traditional cost structures & models of service delivery. HSE South 33
HOSPITAL SERVICES
This Regional Service Plan outlines the resource provided and key deliverables required for each hospital. Implementation of the National Clinical Programmes & SDU initiatives for each hospital are outlined in this plan.
Overall additional investment of €6m is being provided to support the change initiatives including the appointment of 50 additional staff including 20 Consultant posts. Given that CUH is a regional hospital & cancer centre which also provides a significant range of national specialties, and WRH being the south east cancer centre and having a regional service component, these two hospitals are prioritised in the allocation of the development funding receiving €1.9m and €2m respectively. However, each hospital in the region is being provided with some additional resource to support their overall implementation of the national clinical programmes. The details are outlined in the individual hospital schedules in the following pages.
A key focus for each hospital in 2012 will be to maximise delivery on the SDU targets for scheduled and unscheduled care with an absolute priority to substantially reduce the ED trolley issues.
Management Structures and Processes Within HSE South during 2011 we commenced the next phase of implementing our organisational structures and process across the two hospital networks. This is being done to ensure a cohesive approach to the management of the hospitals in each network, and in supporting the development of clinical leadership and the roll out of the clinical directorate model. These processes are being rolled out in line with the nationally agreed framework “Principles for Establishing Clinical Directorates”. They will position the region well to engage proactively with the new health reform programme being implemented by the Minister for Health.
An Acute Hospital Executive Management Group will be established in each network. The group in Cork/Kerry commenced in May 2011. The membership consists of the executive decision makers with responsibility for implementation of the Service Plan within and across the acute hospital sites including CEO/Hospital Manager, Executive Clinical Directors (currently Clinical Directors), OP’s Managers in the community and is chaired by the two Area Managers. The Clinical Directors who will be appointed shortly to each of the four clinical directorates will also be members of the group. While the accountability continues to rest with the Area Management Team and individual hospitals, the Executive Management Group supports collaborative working and ensures coordinated implementation of the service plan in a strategic way across the network, including the implementation of national clinical programmes and the reorganisation of acute hospital services. Some of the specific areas that they will focus on in 2012 include . Establish outpatients central referrals office for acute hospitals in Cork and Kerry. . Implement electronic GP referral processes for Acute Hospitals in Cork and Kerry. . Prepare a comprehensive plan for rehabilitation services across acute hospitals and community settings. . Review delivery of Laboratory services in all Acute Hospitals to meet service needs with optimal efficiency. . Continued roll out of LEAN management project
The Regional Director and senior members of the Regional Management Team attend the Executive Management Group on a quarterly basis to support the overall performance management process and to clear any obstacles or issues that are impeding the effective implementation of our change programmes across the network, or the performance of any individual hospital.
Similarly, in the South East an Acute Hospital Executive Management Group is being established in early 2012. The membership will consist of the executive decision makers with responsibility for implementation of the Service Plan within and across the acute hospital sites including Hospital Managers, Executive Clinical Directors (currently Clinical Directors), Operations Managers in the community and be chaired by the two Area Managers. The Clinical Directors who will be appointed shortly to each of the four clinical directorates will also be members of the group. While the accountability continues to rest with the Area Management Team and individual hospitals, the Executive Management Group will support collaborative working and ensures coordinated implementation of the service plan in a strategic way across the network. This group will oversee implementation of the Regional Service Plan and the National Clinical Programmes across the Network of hospitals and provide an engagement forum between the RDO and Senior Management Team and the Executive Clinical Directors in the South East.
We will be proceeding to appoint Executive Clinical Directors and Clinical Directors across the acute hospital system in HSE South in 2012. Executive Clinical Directors will be appointed to Model 3 and Model 4 hospitals. In addition, each acute hospital network will have Clinical Directors in each of four Clinical Directorates, i.e. medicine, perioperative, diagnostics and women and children. The Clinical Director will be based in the Model 4 hospital, but will have a role in service planning and clinical governance in respect of the services provided in that directorate across all hospitals in the network.
In Cork and Kerry, the Reconfiguration Forum provided an opportunity for consultation, discussion and consensus building which contributed significantly to the process of developing the Roadmap for Acute Hospital HSE South 34
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Services, published in November 2010. As we progress implementation, and taking on board the emergence of the SDU and the national clinical programmes, the overall arrangements have been reorganised.
The Reconfiguration Forum is now re-established with new membership and terms of reference under the chairmanship of Prof John Higgins, Head of the College of Medicine and Life Sciences at UCC. The Forum will be a consultative and advisory body, which will provide the mechanism for engagement, consultation and advice to senior managers, clinical leaders and project managers involved in the reorganisation of the hospital services in Cork and Kerry to ensure that the process is in line with the vision and the principles of the Roadmap. A full programme of work will be finalised in Q1 as the new process is bedded in.
The Non-Executive Advisory Board remains in place and connections between the Advisory Board, the new Forum and the Regional Management Team have been strengthened with joint meetings and greater communication between key office holders. By linking the Advisory Board, the new Forum and the Regional Management Team in this way, we will be able to focus all the expertise at our disposal on the many challenges that confront us in implementing the roadmap and reorganising the hospital system in line with government policy.
Cork University Hospital Group (CUHG) National Clinical Programmes, Service Development & Reorganisation . Acute Medicine Programme – Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days – 4 additional Acute Medicine Physicians and 1 Consultant Radiologist additional resource assigned to support the implementation of this programme and the full operationalisation of the Acute Medical Assessment Unit. Fully implement the recommendations of the Acute Medicine Programme review undertaken in December 2011 . Emergency Medicine Programme (EMP) – Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care –2 additional ED Consultants assigned to support the implementation of this programme . Surgery – Programme focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures. This will be complemented by the implementation of The Productive Operating Theatre (TPOT) in all theatres and the opening of a Surgical Assessment Unit and Day of Surgery Admission (DOSA) Lounge. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols. . Fully implement the reorganisation of surgical services as led by Mr. Denis Richardson - Establish emergency surgery rota for all Cork hospitals, based in CUH, with access to an emergency theatre and to surgical assessment and admission unit. . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways & establishment of acute unit - 1 CNM2, .5 Physiotherapist, .5 Speech & Language Therapist assigned to support the implementation of this programme and the opening of Stroke Unit . Epilepsy – Commence implementation of new regional Adult & Paediatric Epilepsy Centre - 2 Neurophysological Measurement Technicians, 10.5 nurses (incl. 1 Paediatric nurse) and 1 administrative post, assigned to support the implementation of this programme . Neurology – Focus of this programme on reducing OPD waiting lists - 2 Consultant Neurologists and 1 Consultant Paediatric Neurologist assigned to support the implementation of this programme . Acute Coronary Syndrome – Focus of this programme on ensuring timely and appropriate care for cardiac patients - 1 Consultant Cardiologist assigned to support the implementation of this programme. Detailed programme to be signed off at hospital, area and regional level . Heart Failure – 2 nurses and .5 administrative post assigned to support the implementation of this programme . COPD – Implementation of programme targets to reduce admissions and average length of stay (ALOS) - 1 Senior Physiotherapist, 1 nurse and .5 administrative post assigned to support the implementation of this programme. Detailed programme to be signed off at hospital, area and regional level . Critical Care – 1.5 Nurses resource assigned to support the implementation of this programme. This resource will be made available initially to provide clinical care and when the audit of critical care services is ready to roll out, will be assigned to support the audit . Engage with and support all Clinical Programmes as they come on stream for implementation . Commissioning of new publicly owned M.R.I. Scanner . Provision of PET scanner (Q2) . Rollout of IMRT Radiotherapy Programme . Implementation of 4 Clinical Directorates . Commence infrastructure for the development of paediatric services to consolidate paediatric hospital services in CUH. . Develop detailed implementation plan to consolidate medical oncology in CUH.
National Cancer Control Programme . Transfer of Rectal, Prostate, Upper G.I. & Pancreatic Cancer from MUH to CUH. See separate National Cancer Control Programme section of this plan . Transfer of Gynaecological Cancer service from SIVUH
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Cork University Hospital Group (CUHG) Contd. Small Hospital Framework . Fully implement the small hospital framework as agreed for 2012 in respect of MGH and BGH, in particular transfer of agreed volumes of daycase activity to reduce pressure on CUH and to maximise the utilisation of MGH and BGH
Cost Management & Employment Control Measures . Impact of capacity reduction to be mitigated through implementation of national clinical programmes, specifically Surgery and other associated programmes – Closure of 35 surgical beds – Reconfigure 35 beds from 7 day to 5 day – Seasonal closures and comprehensive structured annual leave . Review of rosters and staffing levels . Reduction in sick leave . CUMH – Closure of 8 – 10 Postnatal beds on a rotational basis in Wards 3 South, 3 East and 2 East. . Ongoing review and reduction of Medical Overtime / Agency . Reduce on Call payments in Theatre, Cathlabs . Reduce Agency staffing in Clinical Support Services . Income generation and collection . Pathology Efficiencies -reduced internal and external tests through revised protocols for ordering lab tests. . Radiology efficiencies through – Implementation of Labour Court recommendations – Reduction in out of hours from opening of second Cath Lab . Reorganisation of clinical administrative staff and structures through the implementation of the Clinical Administrative Secretarial Services (CASS) Project in CUH . Non-pay Reduction: – Medical & Surgical appliances through reduced activity, price reductions and ongoing tight control on approvals – Medicines, review of usage and price reductions. – Other Non-pay savings, e.g. Admin expenses, Transport & Staff Travel, Laundry and Postage;
Improving our Infrastructure . Full implementation of the Acute Medical Assessment Unit – Q1 2012 . CUH - Upgrading and refurbishment of existing Cardiac theatres to create additional trauma and emergency theatres – Q3 2012 . CUH - Refurbish an existing ward area to provide a surgical assessment and admission unit – Q3 2012 . CUMH - Upgrade of existing recovery area to create an Emergency Obstetric Theatre – Q1 2012
2012 Planned Activity . Inpatient: 26,696 (CUH) 13,740 (CUMH) Day Case: 55,297 (CUH) 5,360 (CUMH)
Mallow General Hospital (MGH) National Clinical Programmes, Service Development & Reorganisation . Implementation of Small Hospital Framework . Increase in volume and range of day surgery . Commence Advanced Paramedic Rollout . Open Local Injuries Unit . Establish Acute Medical Assessment Unit . Expansion of Endoscopy Services . Establish dedicated patient transport services
Cost Management & Employment Control Measures . Impact of volume reduction is being mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes – Seasonal closures and comprehensive structured annual leave . Medical Roster Revision . Review of Nursing Rosters . General Support Services Initiative – revised Weekend Roster . Non-pay Cost Reduction . Pathology Restructuring . Income generation – Car Parking
Improving our Infrastructure . Acute Medical Assessment Unit – Q3 2012 . Day Procedures Unit - Endoscopy Suite (reorganisation of acute services) – Q3 2012
2012 Planned Activity . Inpatient: 2,956 Day Case 3,500
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Bantry General Hospital (BGH) National Clinical Programmes, Service Development & Reorganisation . Implementation of Small Hospital Framework . Increase in volume and range of day surgery . Rollout of outreach Endoscopy Service; . Open Local Injuries Unit . Establish dedicated patient transport services . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways - .5 CNM2 and .5 Dietician assigned to support the implementation of this programme
Cost Management & Employment Control Measures . Impact of volume reduction is being mitigated through the implementation of National Clinical Programmes, service developments & Reorganisation outlined above, i.e. Surgery, Acute Medicine & ED and other associated programmes – Seasonal closures and comprehensive structured annual leave . Review of nursing rosters and staffing levels . Re-organisation of Staffing rosters to cover planned leave; . Non-pay Efficiencies; . Rolling 2011 Cost Containment Plans which will be carried forward into 2012, e.g.: – Reduction in Agency Costs: – Cessation in Theatre On-Call.
2012 Planned Activity . Inpatient 1,889 Day Case: 1,725
South Infirmary Victoria University Hospital (SIVUH) National Clinical Programmes, Service Development & Reorganisation . Full implementation of reorganised orthopaedic service consistent with prospective funding programme . Rheumatology & Orthopaedic –– 2 Physiotherapists assigned to support the implementation of this programme . Dermatology – 1 Consultant Dermatologist assigned to support the implementation of this programme . Transfer of ophthalmology inpatient and day surgery from CUH . Transfer of non cancer gynaecology from CUMH . Fully implement the reorganisation of surgical services as led by Mr. Denis Richardson . Elective Surgery Programme – programme focussed on implementing national ALOS and daycase targets for most common elective and inpatient procedures through the implementation of TPOT in all theatres. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters while having regard to normal clinical protocols. . Conclude reorganisation of ED Department following completion of work of city-wide clinical group led by Dr. Colm Henry. Finalisation of this plan will be cleared by the Regional Management Team in consultation with the SDU and Acute Medicine Programme . Fully operationalise regional Pain Medicine Unit . Recommencement of Paediatric Orthopaedic Service
Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes – Seasonal closures and comprehensive structured annual leave . Increased income generation from – Increased day case designation – Increased focus on elective activity – Full year impact of bed closures in 2011 – Reduction in replacement of staff on maternity leave – Reduce nursing agency costs – Reduction in medical overtime
Improving our Infrastructure . Commence ophthalmology OPD facility
2012 Planned Activity . Inpatient: 7,985 Day Case: 18,069
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Mercy University Hospital (MUH) National Clinical Programmes, Service Development & Reorganisation . Acute Medicine Programme – Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days. Commence development of Acute Medical Assessment Unit and review the utilisation of medical beds with the support of the National Clinical Programmes and SDU team . Establishment of Short Stay Medical Unit . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways & establishment of acute unit - 1 CNM2 and .5 Occupational Therapist assigned to support the implementation of this programme . Emergency Medicine Programme - Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care . COPD – 1 Physiotherapist, 1 nurse and .5 administrative post assigned to support the implementation of this programme . Elective Surgery Programme – Programme focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures, through implementation of TPOT in all theatres. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols. . Fully implement the reorganisation of surgical services as led by Mr. Denis Richardson . Transfer specific non cancer surgery from CUH. . Development of regional gastroenterology service . Acute Coronary Syndrome - Focus of this programme on ensuring timely and appropriate care for cardiac patients . Asthma – implementation of programme targets . Establishment of Short Stay Medical Unit . Implementation of plans for Gastroenterology services . Full commissioning of Urgent Care Centre in St. Mary’s Health Campus
Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through implementation of national clinical programmes, specifically Surgery and other associated programmes outlined above – Closure of 1 theatre and 12 surgical beds – Closure of 6 paediatric beds – Seasonal closures and comprehensive structured annual leave . Income Generation through increased occupancy of private beds . Reorganisation of admin staff . Non-pay Initiatives – Procurement pharmacy costs; – Contract renewals for MRI Service; – Insurance premiums; – Review of Leases
Improving our Infrastructure . Upgrade existing ward at St. Mary’s Health Campus to facilitate relocation of the Mercy University Hospital OPD to SMOH – Q4 2012
2012 Planned Activity . Inpatient: 8,684 Day Case: 19,324
Kerry General Hospital (KGH) National Clinical Programmes, Service Development & Reorganisation . Acute Medicine Programme – Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days . Emergency Medicine Programme - Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care . Stroke – commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways & establishment of acute unit – 1 CNM2 and 1 Speech & Language Therapist assigned to support the implementation of this programme . Rheumatology – 1 Consultant Rheumatologist assigned to support the implementation of this programme . Diabetes – Continued roll out of this programme locally – 1.25 Podiatrists assigned to support the implementation of this programme . Surgery - Programme focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures, through implementation of TPOT in all theatres. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols.
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Kerry General Hospital (KGH) Contd. . Acute Coronary Syndrome - Focus of this programme on ensuring timely and appropriate care for cardiac patients . Obs/Gynae - Continued roll out of national programme elements e.g. policies and procedures issued by national lead. 4th Consultant Obs/Gynae post to be re-advertised. . OPD restructuring – Implement national clinical guidelines e.g. process improvements / patient pathways . Implementation of Clinical Divisions – Rollout locally . Mapping & shaping delivery of medical services into the future . CNU opening . Establish & management of processes for patient transfers . ICT Various initiatives e.g. NIMIS Qtr 3 2012 . Development of Endoscopy service in order to comply with JAG accreditation standards . Reorganisation of Catering services - streamlining the catering process and utilising improved technology to enable the release of MTA staff to the wards from the Catering function. This will help to address service pressures on the wards and will also lead to more appropriate staffing levels in Catering, making the service more sustainable into the future . Reorganisation of administration services - there are a number of initiatives currently underway which will lead to more efficiencies within the administration function and enable services to be maintained with fewer staff. These include the use of scanners for tracking records, the implementation of a new process for Interim Discharge Letters, the restructuring of the administration function focussing on more local decision-making and a revised arrangement for the maintenance of records on-site . Focus on Absenteeism - a number of targeted initiatives aimed at bringing absence levels into line with national targets
Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes – Seasonal closures and comprehensive structured annual leave . Reduction in Medical Overtime . Eliminate Consultant Locums in selected specialties . Elimination of Agency NCHDs . Elimination of nursing agency/OT and revisit nursing rosters . Reduction in surgical/medical consumables . Reduce security costs . Negotiate price reduction for MRI's . Reduce drug costs . Income generation and collection
Improving our Infrastructure . Emergency Department (phased) and AMAU
2012 Planned Activity . Inpatient: 13,936 Day Case: 9,843
Waterford Regional Hospital (WRH) National Clinical Programmes, Service Development & Reorganisation In line with NSP 2012, WRH as the Regional Hospital and cancer centre for the South East will be adjusting its Inpatient and Daycase activity by a 3% reduction vs 2011 outturn. This reduction is based on 3.76% budget reduction and having regard to €8.4m core deficit for 2012. Activity levels for 2012 will be sustained at this modest reduction based on the implementation of the National Clinical Programmes and targets as specified in the NSP. The Emergency Medicine, Acute Medicine Programme, Elective Surgery Programme and NCCP Key Performance Indicators (KPIs) and the associated national targets for unscheduled and scheduled care in line with DoH/SDU policy are the key performance measures underpinning same. . Acute Medicine Programme – Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days and reduced ALOS – 2 additional Acute Medicine Physician posts ( including 1 Consultant Endocrinologist) assigned to support the implementation of this programme . Emergency Medicine Programme – Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care - 2 Emergency Medicine Consultants assigned to support the implementation of this programme . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways & establishment of acute unit – 1 CNM2 and .5 Physiotherapist assigned to support the implementation of this programme . Elective Surgery Programme - Programme focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures, through implementation of TPOT in all theatres. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols.
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Waterford Regional Hospital (WRH) Contd. . Pilot Protected Surgical In-Patient Beds - Commencing January 2012 . Diabetes – Continued roll out of this programme locally in conjunction with AMP programme, a consultant physician with a special interest in Endocrinology (as outlined above) and 1.75 Podiatrist assigned to support the implementation of this programme . Acute Coronary Syndrome – Focus of this programme on ensuring timely and appropriate care for cardiac patients - 1 Consultant Cardiologist assigned to support the implementation of this programme. The full year cost is being made available to the hospital, the post will be implemented on a half year basis from July to enable the detailed plan and programme of work to be agreed and the non-pay cost to be worked through . Heart Failure – 1 Nursing and .5 administrative post assigned to support the implementation of this programme. . Critical Care - .75 Nurse resource assigned to support the implementation of this programme. This resource will be made available initially to provide clinical care and when the audit of critical care services is ready to roll out, will be assigned to support the audit . Neurology – Focus of this programme on reducing OPD waiting lists - 1 Consultant Neurologist assigned to support the implementation of this programme . Dermatology – 1 Consultant Dermatologist assigned to support the implementation of this programme . Rheumatology & Orthopaedics – 2 Physiotherapists assigned to support the implementation of this programme . Short stay unit – diagnostics special initiative feasibility study . Service Delivery Model for Gynae Cancer to be finalised
National Cancer Control Programme . Rapid Access Prostate Service - Replacement of retired Consultant Urologist 2012 and the progression of a 2nd Consultant Urologist to meet Regional Urology requirements Post is to be progressed to support the increased demand for Urology Services from the commencement of the Rapid Access prostate Service in line with NCCP Policy at the end of 2011. Joint funding from NCCP and WRH agreed in respect of 1 post – 2nd Post will progress in second half of 2012 based on successful implementation of the overall plan. . Gynae – Oncology Service - In line with the NCCP and Maternity Clinical Programme priorities as specified in the National Service Plan 2012 the Service Delivery Model for Gynae Cancer for the South East is to be finalised – Q3 2012 . Dermatology Skin Cancer Service - The 2nd Consultant Dermatologist is being processed for appointment in 2012. A new facility is being refurbished to accommodate the service expansion and will be completed in May 2012
Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes – Closure of 25 surgical beds – 1 Operating Theatre Closure – 1 ICU – efficiencies generated through opening 4 HDU beds – 4 Paediatric inpatient beds. – Seasonal closures and comprehensive structured annual leave . Clinical services internally will be aligned with the CCP and staffing reductions in line with impact of Resignations 2012. In addition to the reduced inpatient (25 beds) and Theatre capacity (2), 1 Intensive care Unit Bed (ICU) and 2 Paediatric Day beds will close. The impact of the ICU bed will be mitigated by the availability of the High Dependency Unit (HDU) which opened at end of 2011. The impact of the Paediatric Day Care bed reduction will be mitigated by efficiencies in line with the Elective Surgery and TPOT Clinical Programmes. . Efficiencies in Regional Dept of Laboratory Medicine - These efficiencies will be achieved by introduction where possible of evidence based clinical protocols to standardise demand, optimise appropriateness of specialist testing and minimise duplicate testing to manage year on year increased demand across the acute and community services. . Efficiencies in the medical pay budget - This initiative requires the restructuring of the Regional Vitreo Retinal Ophthalmic Service and the associated consultant post. Temporary Consultant Post with Special Interest Vitreo Retinal will cease end February 2012 and an alternative service delivery model will be progressed . Further reduction in agency expenditure - Elimination of medical agency expenditure 2nd half of 2011 will apply for the full year 2012. Nursing agency, Laboratory Scientific staff and Catering Services costs will further reduce in 2012. . Efficiencies in the use of high drugs cost in the acute settings . Increase car park charges . Income generation and collection . In line with NSP 2012 priorities re services for Older People 5 WTE nursing staff and 2.5 WTE Healthcare Attendant Staff will be transferred to Waterford Community services to open up additional intermediate care capacity and reduce demand on acute hospital services.
Improving our Infrastructure . ED extension including Neonatal Unit – Q4 2012
2012 Planned Activity . Inpatient: 22,237 Day Case: 19,564
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Wexford General Hospital (WGH) National Clinical Programmes, Service Development & Reorganisation . Acute Medicine Programme – Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days – 1 Acute Medicine Physician assigned to support the implementation of this programme . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways – 1 CNM2 and .5 Physiotherapist assigned to support the implementation of this programme . COPD – 1 Physiotherapist (Respiratory), 1 nurse and .5 admin post assigned to support the implementation of this programme . Diabetes – 1 Podiatrist assigned to support the implementation of this programme . Acute Coronary Syndrome - Focus of this programme on ensuring timely and appropriate care for cardiac patients . Heart Failure – 1 nurse and .5 administrative post assigned to support this programme . Emergency Medicine Programme - Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care . Elective Surgery Programme– Programme focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures, through implementation of TPOT in all theatres. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols. . Pilot Protected Surgical In-Patient Beds - Commencing January 2012 . Short stay unit – diagnostics special initiative feasibility study . Business Case for Special Initiative WGH 2012 (Development of Models of Care) – A business case is being prepared to establish the feasibility of developing a 10 bed short stay unit which would target a cohort of patients for diagnostic type procedure such as endoscopy, acute abdominal investigations and a range of other targeted procedures. Business case to be developed in Q1.
Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes . Seasonal closures and comprehensive structured annual leave bringing inpatient, outpatient and day case activity in line with funded levels . Further reduction in Locum costs equivalent to 15 WTEs across all service areas. . Reduction in staff on call . Increase car park charges . Income generation and collection
Improving our Infrastructure . Continue development of A&E Department, New Delivery Suite and Obstetric Theatre
2012 Planned Activity . Inpatient: 14,890 Day Case: 9,300
St Luke’s General Hospital incl. Kilcreene Orthopaedic Hospital (SLGH) National Clinical Programmes, Service Development & Reorganisation . Acute Medicine Programme - Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days – 1 Consultant Radiologist and 1 Consultant Respiratory & General Physician assigned to support the implementation of this programme . Asthma – this programme will be supported by the new Consultant Respiratory Physician (AMP) and the existing Respiratory Nurse . Acute Coronary Syndrome - Focus of this programme on ensuring timely and appropriate care for cardiac patients . Diabetes – 1.25 Podiatrists assigned to support the implementation of this programme . Emergency Medicine Programme - Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways - 1 CNM2 assigned to support the implementation of this programme . Elective Surgery Programme - focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures, through continued implementation of TPOT and roll out to obstetrics / orthopaedics in all theatres. TPOT rolled out to Kilcreene during 2012. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols. . Obs/Gynae – the local implementation group is in place and is implementing guidelines in accordance with the national programme. . Commence enabling works for the approved €13m Capital Project for the Susie Long Day Services Unit A/E&AMAU Q1 2012
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St Luke’s General Hospital incl. Kilcreene Orthopaedic Hospital (SLGH) Contd. . NIMIS - Installation of digital & filmless systems for Radiology . Roll out of New Born Hearing Screening as part of national project . Continue the Depuy ASR recall at Kilcreene Orthopaedic Hospital and Prospective Funding Initiative . Develop an integrated care model for Paediatric Diabetes Management . Pilot for Productive Ward Surgical 2 ward (under the auspices of the NMPDU) and in line with national clinical programmes . Day of Surgery Admission (DOSA) will reduce the average length of stay and will maximise the number of patients that can be treated while reducing the number of bed days used. . A discharge lounge will be used as a DOSA admission area as promoted through TPOT.
Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes – Reduction in costs in line with nationally agreed Laboratory & Radiology agreements under the PSA along with intensified demand management. AMP and Radiological programme will drive protocols to reduce any unnecessary demand. – Further seasonal closure (June – October) of 10 inpatient beds – Comprehensive structured annual leave . Elimination of agency locums and more efficient rostering of NCHDs in line with the European Working Time Directive. . Further reorganisation across all services to accommodate the impact of the moratorium . Maximise contract savings on Laboratory Equipment, Radiology and Medical/Surgical consumables . Income generation and collection . Non pay efficiencies across all areas in terms of procurement efficiencies and minimising waste. . Increased hospital staff canteen charges
Improving our Infrastructure . Commence enabling works for the redevelopment of ED / AMAU and Day Service Unit (Susie Long Unit) in Q1 with construction commencing in Q3
2012 Planned Activity . Inpatient: 13,487 (SLGH) 897 (KOH) Day Case: 11,545 (SLGH) 920 (KOH)
South Tipperary General Hospital (STGH) National Clinical Programmes, Service Development & Reorganisation . Acute Medicine Programme – Implementation of programme targets / focus on same day and early discharge i.e. within 0 to 2 days. The AMAU will continue to use initiatives to promote rapid diagnosis and admission avoidance, reducing emergency admissions and reducing ALOS for patients who are managed through the acute medical pathway. . Emergency Medicine Programme - Implementation of the EMP to improve the safety and quality of care in EDs and to reduce waiting times for patients and to improve cost effectiveness in emergency care . Stroke – Commence implementation of programme targets / reduce ALOS by 2 days over 3 years / Development of patient pathways – 1 CNM2 and .5 Speech & Language Therapist assigned to support the implementation of this programme . Obs/Gynae – commencement of an early pregnancy assessment unit . Local implementation group is in place and is implementing guidelines in accordance with the national programme. . Acute Coronary Syndrome - Focus of this programme on ensuring timely and appropriate care for cardiac patients . Elective Surgery Programme - Programme focussed on implementing national average length of stay and day case targets for most common elective and inpatient procedures, through implementation of TPOT in all theatres. The continuation of ring fenced elective beds in the hospital’s 5 day elective ward opened in September 2011 will produce further improvements in Day case rates, ALOS and Day of Surgery Admission (DOSA). Development of Surgical Assessment Unit and Admission Protocols for abdominal pain will be employed to create efficiencies in the emergency surgical pathway. Particular requirement to ensure that the organisation of surgical procedures is in line with the requirements of the SDU and that patients are seen in a chronological order to address the requirements of long waiters, while having regard to normal clinical protocols. . NIMIS - Installation of digital & filmless systems for Radiology . JAG accreditation of STGH Endoscopy Service . Pilot site for endoscopy IT system rollout . Diabetes - Pilot site for Integrated Care model for Diabetes management - this will involve the management of Diabetic patients outside of the acute setting through joint working and utilising an integrated approach with Community services and GPs . Business Case for Special Initiative for STGH for provision of additional endoscopy and surgical capacity to address national waiting lists.
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South Tipperary General Hospital (STGH) Contd. Cost Management & Employment Control Measures . Impact of volume reduction to be mitigated through the implementation of National Clinical Programmes, Service Developments & Reorganisation outlined above, in particular Surgery, Acute Medicine & ED and other associated programmes – Continued focus and improvements in elective and emergency patient pathways will enable the 10 beds closed in 2011 to be carried forward to 2012. The 5 day elective ward with ring fenced beds for both Surgical and medical Elective patients continues to improve Day of Admission targets – Through the management of minor surgery in alternative settings there will be a reduction in Day case activity – Seasonal bed & theatre closures and comprehensive structured annual leave . Changes to NCHD rosters to reduce rostered overtime hours when on call, unrostered overtime and NCHD pay costs . Reduction in Consultant Locum through management of capacity and demand for Scheduled care over a 43 week year to reflect Consultant leave allocation . Income generation and collection . Contract savings on Laboratory Equipment, Radiology and Medical/Surgical consumables
2012 Planned Activity . Inpatient: 11,561 Day Case: 7,523
Key Result Areas The following Key Performance Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Clinical Programmes Acute Medicine We will further develop and Acute Medicine model fully operational in 18 initial sites Ongoing implement clinical National Early Warning operational in a targeted number of sites programmes with a particular focus on delivering Emergency Medicine Programme guidelines, protocols, Implement improved patient access to Consultant delivered care Q2 pathways, clinical decision Improve ED throughput by implementation of process, system and measurement Q4 making tools and associated improvements metrics. This will provide implementation support by Establish Emergency Care networks Q1 way of education and clinical Stroke leadership engagement. Stroke units operational to KPI standard Q3 Explore development of stroke rehabilitation units in a targeted number of sites Q2 Provision of 24/7 Thrombolysis in all hospitals admitting acute stroke patients Q2 All patients to have rapid access to specialist TIA (transient ischemic attack) services Q4 Implement the stroke register in 80% of all hospitals admitted acute stroke patients Q3 Critical Care Implement critical care audit nationally on a phased basis Ongoing Heart Failure Roll out of heart failure guidelines and protocols Q1 Structured heart failure programmes operational in 12 acute hospitals Q1 Acute Coronary Syndrome Pre-hospital protocols for all ACS (STEMI and Non-STEMI ACS) in place Q2 Minimum of four Primary PCI centres in operation Q2 Chronic Obstructive Pulmonary Disease (COPD) Implement COPD register / data set Q3 Structured COPD outreach programme operational in 12 acute hospitals Q1 Asthma Develop national model of care for asthma together with implementation plan Q3 Asthma Education Programme operational Q2 Diabetes Commence phased roll out of chronic disease management for diabetes Q4 Roll out of subcutaneous CSII for treatment (for under fives) (insulin pumps) Q3 Continue to implement the national diabetic retinopathy screening programme Ongoing Implement the national footcare programme Q2
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Target Completion Key Result Area Deliverable Output 2012 Quarter Develop national guidelines for diabetes in pregnancy Q4 Renal Maintain / increase number of renal transplants performed by National Renal Transplant Q4 Programme with a target of 200 procedures 2012 Expand the no. of patients accessing home (peritoneal dialysis and home haemodialysis) Q4 therapies from 245 in 2011 to 280 procedures 2012 National Peritoneal Dialysis Tender in 2012 Q2 Commission six contracted satellite haemodialysis units to ensure adequate capacity and Q4 geographic spread of access for the growth in haemodialysis demand in 2012 Enhance procurement of equipment and consumables processes to ensure access to the Q4 most modern equipment in the remaining two of the eleven networks of renal units in 2012 Roll out of Kidney Disease Clinical Patient Management System to the remaining six of the Q4 eleven networks of Renal Units in 2012 and 2013 Radiology Optimise service to meet turnaround times for unscheduled care in line with AMP / EMP Q4 programmes Outpatient Antimicrobial Therapy OPAT Award tender for national compounder Q2 Establish five regional OPAT centres Q4 Roll out national registry Q3 Palliative Care Develop palliative care competency framework Q3 Care of the Elderly Roll out comprehensive geriatric service model in those sites where configuration of geriatric Q2 trained resources is possible Surgical Care Implement Average Length of Stay (AvLOS) Programme and associated reporting tool in six Q4 sites Support the attainment of National Elective Surgery wait list targets Ongoing Establish Acute Surgery Programme Q2 Productive theatre programme operational in nine sites Q4 Outpatient programmes: dermatology, neurology, orthopaedics, epilepsy, rheumatology 30% increase in new patient attendances and wait list targets achieved Q4 Implement national clinical guidelines and pathways Q4 Six Regional Epilepsy Centres operational Q3 12 musculo-skeletal physiotherapy led clinics for rheumatology and orthopaedics Q2 operational Paediatric Care National Model of Care and associated guidelines designed Q4 Neonatal Retrieval Design and implement Phase 1 (Dublin Maternity Hospitals) of a National 24/7 Neonatal Q4 Retrieval Transfer Service Obstetrics and Gynaecology Services Develop strategic five year workforce plan for Obstetrics and Gynaecology Q3 Establish local process improvement / implementation teams in the 19 maternity sites Q2 Develop, disseminate and implement national guidelines Q4 Audiology Services These actions are specific to the clinical programmes. Please also see Primary Care Appoint National and Regional Leads Ongoing Develop patient management system Implement workforce planning recommendations of National Review of Audiology Services Integration of community and acute audiology services into a single managerial and clinical structure Rehabilitation Develop regional networks, local rehabilitation teams and associated protocols, pathways Q1 and bundles In association with other programmes (e.g. Stroke, Care of the Elderly) define an enhanced Q2
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HOSPITAL SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter model for community based rehabilitation services Medication Management Develop strategic plan for medicines management for older people Q2 Undertake analysis of biologic infusion therapies Q1 Haemochromatosis Implement national model of care and guidelines for Haemochromatosis treatment Q2 To establish three regional walk-in venesection clinics, each providing care for 1,250 Q4 patients per location in an integrated care model with GPs Blood Transfusion Establish National Transfusion Committee and Task Force in line with the recommendations Q1 of the National Blood Strategy Implementation Group (NBSIG) Report 2004 Reduction in platelet usage across the hospitals by 3% of 2011 usage – i.e. 2012 usage Ongoing target of 21,500 units Establish framework to deliver reduction in red cell usage of 10% over 2011 baseline over three years 2012 - 2014 Percentage of red cells ordered by hospitals returned unused < 2%; rerouted to hub hospital < 5% Establish methodology to deliver implementation of recommendation 5 of NBSIG Report 2004: reduction of excess O negative blood use, by 2014 Identify and execute savings in procurement of consumables, disposables and equipment through regional level action Resource Allocation Pilot Extend prospective funding model to remaining elective orthopaedic sites Q2 Complete an initiative which Develop a plan to roll out the prospective funding model to other elective surgery services Q2 commenced in 2011 to pilot a change to procedure-based funding of hospital services instead of block grants Cystic Fibrosis National Model of Care and associated guidelines designed Q4 CF Unit to open in St. Vincent’s Hospital (due to be operational Q3, 2012) and planning will Q4 continue for the extension of Mayo General Hospital, Beaumont Hospital and Galway University Hospital in line with recommendations of The Treatment of Cystic Fibrosis in Ireland: Problems and Solutions 2005 (Pollock Report) Hospital Laboratories Continue the consolidation of cold laboratory work in 2012 Q4 Endoscopy Services Complete phase 2 of the procurement project for the Endoscopy Reporting System (ERS) Q2 Provision of high quality, Develop plans for the installation of ERS in remaining 10 public hospitals Q3 timely and accurate services Complete specification for the national database Q1 with associated quality patient experience Smaller Hospitals Publish in conjunction with the Department of Health, the Framework for Smaller Hospitals Q1 Re-organisation of Smaller and the re-organisation plans for 9 smaller hospital sites (to be agreed with Government) Hospitals Undertake a public communication and consultation process nationally on the framework Q1 and locally on the re-organisation process that will be implemented in the 9 sites Undertake a communication and consultation process with HIQA on the plans for smaller Ongoing hospitals and provide monitoring reports as required National Paediatric Hospital Continue development of joint initiatives between the three hospitals that will make up the Ongoing National Paediatric Hospital (Our Lady’s Children’s Hospital Crumlin, Children’s University Hospital Temple Street and National Children’s Hospital within Adelaide and Meath Hospital Tallaght) to: . Implement the relevant national clinical programmes and prepare to operate under this umbrella in the new hospital . Move towards and put in place effective agreed unitary management for the new hospital in line with agreed governance structures for the new hospital to be developed in conjunction with the DoH . Continue to progress the ongoing capital development process working with the National Paediatric Hospital Development Board and Estates National Integrated Implementation of system completed in designated areas: Q4 Management Information St. Luke’s Rathgar, Our Lady’s Hospital for Sick Children, Naas, Connolly, South Infirmary, System South East Region, Mid-West Region, Mayo, Kerry, National Rehabilitation Hospital, St. Enabling radiological services Columcille’s, Mallow, Bantry to be ‘filmless’, with secure Integration of existing PACs sites into NIMIS: Q4 and rapid movement of St. James’, Cork University Hospital, University College Hospital Galway, Tullamore, patient image data through Mullingar, South Infirmary Victoria, Mercy, Letterkenny, Roscommon, Adelaide and Meath HSE South 45
HOSPITAL SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter the health services incorporating the National Children’s Hospital, Temple St. European Working Time Establish a National Working Group on EWTD Q1 Directive for NCHDs Implement EWTD in respect of interns Q2 Implement revised rosters for Senior House Officers (SHOs), Registrars and Specialist Q2-Q3 Registrars that maximise EWTD compliance Report on consequent reduction in hours Q4 Report progress bi-annually Q2 and Q4 Pre-Hospital Emergency Implementation of National Ambulance Service Control Centre Reconfiguration Care Services Project and associated ICT enabling Projects: Re-configure Ambulance Operationalise Control of National Ambulance Service assets Q4 Services to respond to Implement a Patient Equipment Replacement Programme to match Product Lifecycles Q2 changing models of service Prepare the National Ambulance Service to support changes to Acute Hospital Services:
Roll out of Education and Competency Assurance Plan to support ACS Clinical Care Q3 Programme and revised Clinical Practice Guidelines Develop and implement Pre Hospital National Appropriate Hospital Access Protocols for Q4 Paediatrics, Obstetrics, Stroke, ACS and Trauma in conjunction with Clinical Care Programmes Continue to develop suite of key performance indicators with HIQA on pre-hospital Q2 emergency care Develop & maintain HSE Develop policies, standards and . Crowd event procedures Q1 guidance in Emergency . Hospital Major emergency/ major incident plan template Q3 Management . Revise the National Influenza Pandemic Plan Q2 . Procedures for the management of Biological incidents Q2 . Procedures for the management of Chemical incidents Q4 . A National Weather plan Q3 Implement . Crowd event procedures compliant with legislative requirements & HSE procedures Q1 . Commence Hospital Major emergency/ major incident plan template compliance Q4 . Procedures for the management of Biological incidents Q2 . Procedures for the management of Chemical incidents Q4 . Two Emergency Management exercises in each region( one of which must involve a Each quarter CMT) . Seveso site external plans in accordance with EU Directive and HSE National policy Each quarter
Work with other response . Finalise interdepartmental & interagency reviews of Severe Weather Response. Q1 to Q4 and their parent Gov . Improve System of National joint appraisal to deliver on regional compliance with the Q2 Departments agencies to interagency Framework and its associated guidance and protocols further develop national and . Finalise Module 1 of the Interdepartmental Chemical, Biological, Radiological and Q1 regional interagency plans Nuclear Protocol and procedures in . Develop and deliver on programs of interagency training Emergency management. Q1 – Q4 . Conduct 1 interagency exercises in each Region Q2 & Q4
Clinical Programme Performance Indicators A number of key performance indicators have been developed which will support implementation of the clinical programmes and these are set out below. Some targets have been set and can be seen in the full Performance Indicator and Activity Suite. Some programmes will establish indicator baselines during the year, and only then will reporting commence. These will then inform the setting of targets in 2013. In addition, we will develop new performance indicators for other clinical programmes during 2012 (such as neurosurgery, etc.) Acute Medicine . % of all new medical patients attending the acute medical unit (AMU) who spend less than 6 hours from ED registration to AMU departure . Medical patient average length of stay Emergency Medicine Programme . % of all patients arriving by ambulance wait < 20 mins for handover to doctor / nurse . % of new ED patients who leave before completion of treatment . % of patients spending less than 24 hours in Clinical Decision Unit Stroke . % acute stroke patients who spend all or some of their hospital stay in an acute or combined stroke unit HSE South 46
HOSPITAL SERVICES
. % of patients with confirmed acute ischaemic stroke in whom thrombolysis is not contraindicated who receive thrombolysis . % of hospital stay for acute stroke patients in stroke unit who are admitted to an acute or combined stroke unit Heart Failure . Rate (%) re-admission for heart failure within 3 months following discharge from hospital . Median LOS and bed days for patients admitted with principal diagnosis of acute decompensated heart failure . % patients with acute decompensated heart failure who are seen by HF programme during their hospital stay Acute Coronary Syndrome . % STEMI patients (without contraindication to reperfusion therapy) who get PPCI . % reperfused STEMI patients (or LBBB) who get timely PPCI or thrombolysis . Median LOS and bed days for a) STEMI and b) Non-STEMI pts COPD . Mean and median LOS (and bed days) for patients with COPD . % re-admission to same acute hospitals of patients with COPD within 90 days . No. of acute hospitals with COPD outreach programme . % of acute hospitals and Operational Areas with access to Pulmonary Rehabilitation Programme Asthma . % nurses in primary and secondary care who are trained by national asthma programme . No. of asthma bed days prevented annually . No. of deaths caused by asthma annually Diabetes . % reduction in lower limb amputation from Diabetes . % reduction in hospital discharges for lower limb amputation and foot ulcers in diabetics . % of registered Diabetics invited for retinopathy screening Epilepsy . % reduction in Median LOS for epilepsy inpatient discharges . % reduction in no. of bed days for epilepsy inpatient discharges Dermatology OPD . No. of new patients waiting > 3 months for dermatology OPD appointment . Referral: New Attendance ratio Rheumatology OPD . No. of new rheumatology outpatients seen per hospital per year . Referral: New Attendance ratio Neurology OPD . Length of time patients are waiting for neurology outpatient appointment . Referral: New Attendance ratio
Acute Hospitals and National Clinical Programmes Year on year, the HSE faces an increased demand for acute hospital services arising from a range of factors including population ageing and rising levels of chronic disease. Acute hospitals have thus been under considerable budgetary pressure in recent years and capacity will have to be tailored in line with the available funding to ensure financial sustainability. In 2012, hospital budgets will drop on average by 4.4% of last year’s allocation and this will require an expenditure reduction of 7.8% when account is taken of incoming closing run rates (deficits). As a direct result of the budgetary and staff reductions, activity levels would be expected to fall in 2012 by about 6%. Bed capacity in terms of bed days must reduce in proportion to the reduction in resources but increased efficiency of clinical service delivery arising from the impact of the Clinical Programmes will ensure that as many patients as possible will be seen and managed as inpatients or day cases. Therefore, we expect to be able to limit the reduction in activity, as measured by the number of people treated, to an average of 3% against 2011 outturn. Activity reductions will vary from hospital to hospital depending on local circumstances. Hospitals with the greatest carry forward financial challenge will find it most difficult to maintain activity levels and some will require a high intensity management process which in addition to managing significant clinical change will also focus on targeted cost reductions and maximising income billing and collection. The western hospitals are particularly challenged, given the level of the historic deficits. The priority in 2012 will be to stabilise the level of services that can be provided for the available resource and to continue the work of our change programme. The cornerstones of the change programme are the national clinical programmes of care and the rationalisation of services to ensure that best use is made of each hospital site. The national clinical programmes of care provide a national, strategic and co-ordinated approach to a wide range of clinical services. The primary aim of these is to modernise the manner in which hospital services are provided across a wide range of clinical areas through the standardisation of access to, and delivery of, high
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HOSPITAL SERVICES quality, safe and efficient hospital services, maximising linkages to primary care and other community services. Funding of €23.4m will be provided in 2012 to hospital budgets to recruit staff to progress the implementation of the Acute Medicine, Emergency Medicine, Stroke, Surgery and other clinical programmes, building on the work started in 2011. The ongoing policies of moving from inpatient to day case treatment where possible (‘stay to day’), increasing the rate of elective inpatients who have their principal procedure performed on day of admission and reducing the average length of stay will further serve to maximise the number of patients being treated while still reducing the number of bed days required. The HSE has targeted a reduction of 5% in average length of stay in 2012. Decreased hospital activity will impact particularly on elective care, and in this context hospitals will work closely with the Special Delivery Unit (SDU) to ensure that, notwithstanding this reduction, nobody waits longer than 9 months for an elective procedure, thus ensuring equitable access for all. Emergency admissions will be reduced as a result of the impact of the Clinical Programmes as well as ED wait times, which is a critical priority. Reorganisation of ambulance services will continue in 2012, leading to a more efficient use of resources. However, as no additional funding is available in 2012, our ability to address the newly agreed national targets will be challenging.
Activity, Performance Measures and Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Performance Activity Projected Outturn Expected Activity Expected Activity 2011 2011 2012 South South South Discharges Activity* Inpatient 144,000 149,362 144,881 Day Case 163,000 160,884 156,057 % Discharges which are Public Inpatient 80% (National) 78% (National) 80% (National) Day Case 80% (National) 85% (National) 80% (National) Unscheduled Activity No. of emergency presentations 307,500 310,413 307,500 No. of emergency admissions 87,900 94,537 87,900 Outpatients Activity No. of outpatient attendances 714,700 No data available due to To be confirmed by reclassification of metrics Quarter 1 2012 (National) (National) Births Activity Total no. of births 74,200 (National) 73,490 (National) 73,216 (National) Dialysis Modality Haemodialysis 1,650 – 1,740 (National) 1,670 (National) 1,760 – 1,870 (National) Home Therapies 245 – 270 (National) 245 (National) 280 – 290 (National) Total 1,895 – 2,010 (National) 1,915 (National) 2,040 – 2,160 (National) *The actual breakdown of reductions between inpatient and day cases may vary once detailed hospital business plans are finalised ** Dublin Mid Leinster figures do not include St. Luke’s day case activity
Performance Indicators Target 2011 Projected Outturn 2011 Target 2012
National National National ALOS Overall ALOS for all inpatient discharges and deaths 5.6 6 5.6 Overall ALOS for all inpatient discharges and deaths excluding LOS 5 4.7 4.5 over 30 days Inpatients % of elective inpatients who had principal procedure conducted on day 75% 49% 75% of admission
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HOSPITAL SERVICES
Performance Indicators Target 2011 Projected Outturn 2011 Target 2012
% of emergency re-admissions for acute medical conditions to the same New PI 2012 New PI 2012 9.6% hospital within 28 days of discharge No. of people re-admitted to ICU within 48 hours New PI 2012 New PI 2012 New PI 2012 Baseline to be established % of emergency hip fracture surgery carried out within 48 hours (pre-op New PI 2012 80% 95% LOS: 0, 1 or 2) No. of first presentations to hospital with a primary diagnosis of New PI 2012 New PI 2012 New PI 2012 development dysplasia of hip (DDH) at 1 year of age or older Delayed Discharges No. of hospital delayed discharges --- 817 Reduce by 10% Reduction in bed days lost through delayed discharges New PI 2012 New PI 2012 Reduce by 10% Day case % of day case surgeries as % of day case plus inpatients, for a specified 75% 72% 75% basket of procedures Outpatients (OPD) An agreed set of OPD metrics will be in place and reported by Quarter 2 ------To be confirmed by Q1 2012 2012 Births % delivered by Caesarean Section 20% 27% 20% Colonoscopy / Gastrointestinal Service No. of people waiting more than 4 weeks for an urgent colonoscopy 0 0 0 No. and % of people waiting over 3 months following a referral for all New PI 2012 New PI 2012 New PI 2012 gastrointestinal scopes < 5% Unscheduled Care: % of all attendees at ED who are discharged or admitted within 6 hours 100% Data in 2011 was not 95% by Sept. 2012 of registration inclusive of all hospitals. New reporting being introduced in 2012 will capture this data No. and % of patients who were admitted through ED within 9 hours New reporting time band 2012 New reporting time band 100% from registration 2012 Scheduled Care No. and % of adults waiting > 9 months (inpatient) New reporting time band 2012 New reporting time band 0 2012 0%
No. and % of adults waiting > 9 months (day case) 0 0% No. and % of children waiting > 20 weeks (inpatient) 0 1,294 0 60% 0% No. and % of children waiting > 20 weeks (day case) 0 1,312 0 53% 0% Consultant Public: Private Mix Casemix adjusted public private mix by hospital for inpatients 80:20 Under review, baseline 80:20 to be established Casemix adjusted public private mix by hospital for daycase 80:20 80:20
Consultant Contract Compliance % of consultants compliant with contract levels by hospital type (Type B 100% 100% / B* / C) Blood Policy No. of units of platelets ordered in the reporting period 22,000 22,210 21,500 (3% reduction) % of units of platelets outdated in the reporting period < 10% < 4.5% < 10% % usage of O Rhesus negative red blood cells < 11% < 12.9% < 11% % of red blood cell units rerouted to hub hospital < 5% < 4.4% < 5% % of red blood cell units returned out of total red blood cell units ordered < 2% < 1.1% < 2% Health Care Associated Infection (HCAI) Rate of MRSA bloodstream infections in acute hospitals per 1,000 bed 0.085 0.071 < 0.067 days used (Q2 data) Rate of new cases of Clostridium Difficile associated diarrhoea in acute New PI for 2012 3.2 < 3.0
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HOSPITAL SERVICES
Performance Indicators Target 2011 Projected Outturn 2011 Target 2012 hospitals per 10,000 bed days used (Q2 data) Median hospital total antibiotic consumption rate (defined daily dose per 76 86 83 100 bed days) per hospital (combined Q1 and Q2 data) Alcohol Hand Rub consumption (litres per 1,000 bed days used) 23 22.7 23 (combined Q1 and Q2 data) % compliance of hospital staff with the World Health Organisation’s New PI for 2012 75% 85% (WHO) 5 moments of hand hygiene using the national hand hygiene audit tool
Ambulance Projected Outturn Expected Activity Expected Activity 2011 2011 2012 South South South First Responder response times to potential or actual 112 (999) life threatening emergency calls % of Clinical Status 1 ECHO incidents responded to by first responder in 7 minutes and 59 seconds or less
75% (National 56.9% 75% (National) % of Clinical Status 1 DELTA incidents responded to by first responder in 75% (National) 28.2% 75% (National) 7 minutes and 59 seconds or less % of Clinical Status 1 ECHO incidents responded to by a patient-carrying Baseline to be established 69% (National) 80% by June 2012 vehicle in 18 minutes and 59 seconds or less 85% by Dec 2012 (National) % of Clinical Status 1 DELTA incidents responded to by a patient- Baseline to be established 67% (National) 80% by June 2012 carrying vehicle in 18 minutes and 59 seconds or less 85% by Dec 2012 (National)
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National Cancer Control Programme
Introduction The goals of the programmatic approach to cancer services, commenced in 2007 by the National Cancer Control Programme (NCCP), are to improve cancer prevention, detection and increase survival rates. This is being achieved through the development of a comprehensive national service, based on evidence and best practice.
NCCP is working to ensure that designated cancer centres for individual tumour types have adequate case volumes, expertise and a concentration of multi-disciplinary specialist skills. Symptomatic breast diagnosis and treatment and rapid access lung and prostate clinics established in the eight cancer centres since 2009 will continue to be monitored through the collection of monthly key performance indicators. Lung surgery has been centralised into four regional centres.
In 2011, five site specific expert tumour groups were established with the objective of developing evidence based diagnostic and treatment guidelines for breast, prostate, lung, gastrointestinal and gynaecological cancers. This work will be further developed late in 2012, with additional tumour groups to be established for other cancers. In 2012, NCCP will initiate measures to support optimal management of cancer drugs and will pursue the appointment of new consultant medical oncologists. The national cancer screening work programme includes planning to extend BreastCheck to an upper age group, continued provision of cervical screening and preparation for the colorectal screening programme. The 2012 community oncology work programme includes building on its existing partnership with Irish College of General Practitioners, increasing the proportion of electronic referrals and delivering a community nurse training programme for medical oncology patients.
The National Service Plan has identified the following priorities for 2012: . Plan for the extension upwards of the age range for BreastCheck screening, continue CervicalCheck programme and prepare for the launch of the colorectal screening programme in quarter four. . Deliver cancer surgical services, within multidisciplinary diagnostic and therapeutic environments, inclusive of medical and radiation oncology services. . Progress the national medical oncology programme, developing national protocols for drug usage and national practices. . Progress the radiation oncology programme to create a national network of radiotherapy facilities. . Assist and support national expert groups for common cancers established by NCCP for the development of national clinical practice guidelines. . Scope the development of a national cancer information system and support regional IT connectivity to support areas such as electronic prescribing and electronic referral. . Develop professional staff knowledge, through collaboration with relevant colleges and educational bodies. Develop primary care skills in prevention, diagnosis, care, and follow up to facilitate safe, high quality care in the community.
HSE South East – Cancer Programme Business Plan 2012 Key Result Areas
Key Result Target Q Output 2011 Area Deliverables 2012 High level actions Timescale
Lung Cancer . Rapid Access Clinic fully Explore the provision of Monitor activity and KPI’s Q1-Q4 Services operational surgical service to patients Steering Group Meeting with . EBUS is operational from HSE South East with WRH/CUH to be reconvened . Resection rate improvements CUH in 2012. continued Prostate/ . Rapid Access Clinics for prostate Prostate cancer surgery Monitor activity and KPI’s Q1 –Q4 Urology Cancer cancers in WRH established. consolidated at CUH for all of Monitor and review patient Services . Establishment of a Prostate/ HSE South pathways Urology MDT Consider the possibility of . Pathways for patients for having a 1 stop RAC for assessment, diagnosis and prostate. (same day) treatment options established. Progress the recruitment of Consultant Urologist(s) for HSE.SE Launch of Rapid Access Prostate Referral form. Gynae – . Commence the process for the . Plan regional centre for Gynae . Establish joint Gynae Q2 oncology centralisation of gynae-oncology oncology services OncologyMDT’s CUH/WRH. surgical service at WRH.
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Key Result Target Q Output 2011 Area Deliverables 2012 High level actions Timescale
Breast Cancer . Recommendations from HIQA . Implement national protocols . Monitor activity and KPIs Q1-Q4 Services audit Implemented. for family risk. . Monitoring process in place for the . Maintain Breast standards HIQA standards . Participated in national referral and triage audit Rectal cancer . Rectal cancer surgical services . Monitor implementation and . Monitor activity and KPIs Q1-Q4 services centralise at WRH impacts on other surgical . Consolidation of the current services in the region single handed surgical services at WRH- Regional reorganisation of surgical /Rectal Cancer services. Skin cancer . Service configuration and model . Consultant Dermatologist . Commission of ambulatory Q1 services agreed appointed care area . Refurbishment of new ambulatory . Establish a pathway for the area commenced Implementation of the NCCP referral forms for Melanoma and BCC Theatre/ICU/ . Additional theatre, ICU/HDU and . Cancer patients have access to . Monitor activity Q1- Q4 Support support staff provided to enable appropriate/HDU care cancer surgical throughput in designated centre
Medical . 3rd permanent Medical Oncologist . Review medical oncology . Monitor capacity, utilisation Q1-Q4 Oncology to be appointed. services from a quality and KPIs across region . Participated in NCCP national assurance and safety review of Medical Oncology drugs perspective and resources. . Assist in the development of . The business case for the new mechanisms for the build cancer centre reviewed management of the cancer drug nationally. budget within the Community (demand led) schemes section . Adopt national protocols for drug usage and standardised practice as they become available Radiation . SLA/contact for 2011 agreed . Progress the radiation oncology . Monitor activity and KPIs Q1-Q4 Oncology . Contact monitoring arrangements programme with the . Participate in capital agreed and implemented development of facilities as set planning process for phase 2 . Monthly review process in place out in the National Plan for Radiation Oncology (NPRO) within a single clinical framework. . SLA for 2012 agreed . Performance management framework established with WOA Quality and . Lead clinicians participated in the . Lead clinicians participation in . Lead clinicians nominated to Q1-Q4 Safety; Expert national specialist clinical network cohesive national specialist prostate, lung, breast and Tumour Groups clinical networks established by rectal cancer groups NCCP for the purpose of clinical audit, sharing of good practice and problem solving for breast, lung, prostate and rectal cancers Quality Care in . Proportion of electronic GP . Smoke Free Campus . WRH – Tobacco Free Q1-Q4 the Community referrals increased . Promulgate use of standardised Working Group established- . Brief interventions with smoking electronic referral processes Tobacco free Campus at cessations with primary care developed for common tumours WRH 22ND February 2012. teams developed. . Enhance smoking cessation . Pilot of Community Nurse training for all health care Program being undertaken in professionals in partnership Kilkenny. with primary care specialists . GP meetings facilitated by . Participate in delivery of the cancer team at WRH community nurse training continue to be held around programme for cancer acre in the region. HSE South 52
CANCER SERVICES
Key Result Target Q Output 2011 Area Deliverables 2012 High level actions Timescale association with specialist services . Work with local GPs and specialist services to deliver appropriate follow up care for common cancers in the primary care setting as per nationally agreed guidelines and protocols Governance . Performance management . Continue to consolidate . Tumour specific governance Q1-Q4 Arrangements arrangements with Cancer centre regional and national clinical groups in place with leads agreed and implemented governance models in appointed
. Implementation processes collaboration with NCCP . Quarterly review meetings
established for each tumour group . Performance management with GM and Clinical Director
system in place for each group . Resources to support cancer . Audit governance services at WRH identified and arrangements Q1 agreed . Monthly review meetings with Gm/Clinical Director and NCCP . Mechanism for the migration of resources to the cancer centre associated with cancer moves agreed and implemented
HSE South West – Cancer Programme Business Plan 2012 Key Result Areas Key Result Target Q Output 2011 Deliverable 2012 High Level Actions Area Timescale Lung Cancer . Rapid Access Clinic for lung . Continue integration of existing . Monitor activity and KPIs Q1 –Q4 Services cancers in CUH fully operational service at MUH . Develop streamlined . Improve access to surgery pathway to surgical services . Resection rate improvements . Develop business case to continued support development of . Scope potential for the surgical services development of surgical services for patients from HSE SE Urology Cancer . Outreach RAC service . Rapid Access Clinics for prostate . Monitor activity and KPIs Q1 Services established at WRH cancers in CUH established. . Patients pathway and MDM . Integration of existing service at process agreed MUH . Prostate cancer surgery consolidated at CUH for all of HSE South Upper GI . Pre-destination of CUH as upper . Predestination of CUH as upper . Transfer upper GI Cancer Q3 GI cancer centre GI cancer centre Surgery from MUH to CUH . Monitor activity and KPIs Pancreatic . Satellite centre of the national . Complete establishment of . Transfer pancreatic cancer Q1 Surgery centre for pancreatic surgery pancreatic satellite unit in CUH surgical services from MUH established at CUH, fulfilling all linking into St. Vincent’s National to CUH the requirements of the Service Centre . Establish single MDM agreement for the service . Participation in national oversight committee . Monitor activity and KPIs Rectal cancer . Project team in place planning . Complete transfer of rectal . Monitor implementation and Q1 services service move cancer surgery into CUH from impacts on other surgical . Equipment purchased KGH and MUH services in the region . Monitor activity and KPIs . Establish single MDM Brain Tumour . Lead consultant neurosurgeon . Joint processes for the operation . Establishment of joint MDM Q1 – Q4 service appointed of service across two sites . Monitor activity and KPIs . KPIs agreed and monitoring and agreed and implemented review process in place HSE South 53
CANCER SERVICES
Key Result Target Q Output 2011 Deliverable 2012 High Level Actions Area Timescale Head and Neck . Analyse scope of cancer head . Establish project team to Q3 cancer services and neck services plan service transfer
Gynae – . Plan developed to centralise . Plan regional centre for Gynae . Centralise gynae oncology Q3 oncology gynae-oncology surgical service oncology services services at CUH at CUH . Monitor activity and KPIs . Commence works on theatres at CUMH Skin Cancer . National guidelines piloted at . Implement national referral and . Roll out and communication Q1 Service CUH treatment guidelines of guidelines and referral pathways . Additional Oncoplastic . Appoint additional consultant Q1 consultant surgical post Oncoplastic surgeon . Agree configuration of onco approved plastic consultant surgeon post in consultation with NCCP, CUH and SIVUH Breast Cancer . Recommendations from HIQA . Maintain Breast standards . Monitor activity and KPIs Q1-Q4 Services audit Implemented . Implement national protocols for . Audit links with Kerry service . Participate in national referral family risk with view to developing early and triage audit discharge programme for Kerry patients (1 WTE beast care nurse in Kerry) Theatre/ICU/ . Additional theatre, ICU and . Cancer patients have access to . Monitor activity Q1-Q4 Support support staff provided to enable appropriate ITU/HDU care cancer surgical throughput in designated centre. New unit with 6 ITU/HDU beds commissioned Medical . Agreement reached on the . Plan for the centralisation of . Plan approved by RDO and Q1 Oncology provision of Medical Oncology Medical Oncology Services funding secured services Services across the region developed and approved . Monitor activity and KPIs . Participate in review of medical oncology services from a quality assurance and safety perspective . Assist in the development of mechanisms for the management of the cancer drug budget within the Community (demand led) schemes section . Adopt national protocols for drug usage and standardised practice as they become available Radiation . Participated in the National . Progress the radiation oncology . Participate in Phase 2 Q1 –Q4 Oncology performance management and programme with the development Q3 monitoring system development of facilities as set services . Implement IMRT Q4 . Implementation of review out in the National Plan for . Implement Prostate Q1 – Q4 recommendations completed Radiation Oncology (NPRO) Brachtherapy . Project for the development of within a single clinical . Adopt national clinical IMRT and Prostate framework. guidelines as they become Brachytheapy funded and . Participate in the development available and implement commenced of the National Radiation tumour specialisation Oncology Network by: . Monitor activity and KPIS . Implementation of national clinical guidelines and standards . Implement of national performance management and monitoring system . Implement national programme for Prostate Brachytherapy. Quality and . L ead clinicians participated in . Lead clinicians participation in Q1 –Q4 Safety; Expert national specialist clinical cohesive national specialist Tumour networks clinical networks established by Groups NCCP for the purpose of clinical audit, sharing of good practice and problem solving
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CANCER SERVICES
Key Result Target Q Output 2011 Deliverable 2012 High Level Actions Area Timescale for breast, lung, prostate and rectal cancers Quality care in . Proportion of electronic GP . Promulgate use of standardised . Develop local policy for the Q1-Q4 the community referrals increased electronic referral processes support of patients requiring . Practice and community nurse developed for common tumours breast prosthesis training programme developed. . Enhance smoking cessation . Participate in GP education . GP and practice nurse training for all health care events education evenings held professionals in partnership . Participate in community with primary care specialists nursing education events . Participate in delivery of . Provide brief interventions community nurse training training programme for cancer care in association with specialist services . Work with local GPs and specialist services to deliver appropriate follow up care for common cancers in the primary care setting as per nationally agreed guidelines and protocols Governance . Agreed performance . Continue to consolidate . Tumour specific governance Q1-Q4 Arrangements management arrangements regional and national clinical groups in place with leads with NCCP implemented governance models in appointed
. Clinical leads appointed for collaboration with NCCP . Quarterly review meetings
Lung, Prostate and Rectal . Performance management with CEO and EMB for each Cancer Services system in place group . Resources to support cancer . Audit governance service moves into CUH arrangements identified and agreed . Monthly review meetings with CEO/Clinical Director and NCCP . Mechanism for the migration Q1 of resources to the cancer centre associated with cancer moves agreed and implemented PET Scanner . Contact for managed services . PET service operational CUH gone to tender
National Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012
National National National Symptomatic Breast Cancer Services No. of urgent attendances 13,000 13,690 13,000 No. of non urgent attendances 26,000 24,666 25,000 No. and % of attendances whose referrals were triaged as urgent by the 12,350 13,590 12,350 cancer centre and adhered to the HIQA standard of 2 weeks for urgent 95% 99.3% 95% referrals (No. and % offered an appointment that falls within 2 weeks) No. and % of attendances whose referrals were triaged as non-urgent 25,000 23,441 23,750 by the cancer centre and adhered to the HIQA standard of 12 weeks for 95% 95% 95% non-urgent referrals (No. and % offered an appointment that falls within 12 weeks) Breast Cancer Screening No. of women who attend for breast screening New PI for 2012 New PI for 2012 140,000 Lung Cancers No. of attendances at rapid access lung clinic New PI for 2011 1,924 To be determined
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Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012
No. and % of patients attending the rapid access clinic who attended or 95% 1,713 95% were offered an appointment within 10 working days of receipt of 89% referral in the cancer centre Prostate Cancers No. of centres providing surgical services for prostate cancers 5 7 6 No. of new / return attendances and DNAs at rapid access prostate New PI for 2012 New PI for 2012 To be determined clinics No. and % of patients attending the rapid access clinic who attended or New PI for 2012 New PI for 2012 90% were offered an appointment within 20 working days of receipt of referral in the cancer centre Rectal Cancers No. of centres providing services for rectal cancers 8 13 8 Radiotherapy No. of patients who completed radiotherapy treatment for breast, lung, New PI for 2012 New PI for 2012 To be determined rectal or prostate cancer in preceding quarter No. and % of patients undergoing radiotherapy treatment for breast, New PI for 2012 New PI for 2012 90% prostate, lung or rectal cancer who commenced treatment within 15 working days of being deemed ready to treat by the radiation oncologist
HSE South 56
Older People’s Services
Introduction Resources The services we provide aim to support older people to remain independent, in their own home or within their community environment, for as long as FINANCE – HSE SOUTH possible. This is achieved through the provision of home and community- 2011 2012 based support services (including home help services, home care packages, Area Budget Budget respite care, day care, meals on wheels, health promotion initiatives / €m €m programmes, etc). Where this is no longer possible, we support older people Cork 83.727 79.991 in residential care under the Nursing Homes Support Scheme (NHSS). An Kerry 38.004 36.240 additional €55m has been allocated nationally for this scheme in 2012. Carlow /Kilkenny/Sth Tipp 40.098 38.166 The particular challenge for older people services in 2012 will be to respond Waterford/Wexford 35.216 33.693 to the increasing demand for health and social services which is resulting Regional 1.800 1.732 from the growth in the number of older people, particularly in the upper age Total 198.845 189.822 group (over 75yrs), while reducing the overall expenditure on this programme. WTE Ceiling – HSE SOUTH Our priorities for 2012 will be to improve the pathway of care for older people Dec 2011 Projected Area as they access a range of services. This will be supported by the work of the Dec 2012 clinical care programmes. Funding will be focused on the maintenance of the Cork 1,239 1,247 delivery of home care packages enabling those with more complex care Kerry 395 382 needs to remain or return to home. There will also be an ongoing re-focusing of home help services to prioritise personal care provision and essential Carlow /Kilkenny/Sth Tipp 557 540 household duties. We will also work on optimising the provision and quality of Waterford/Wexford 552 535 residential care. Total 2,743 2,704 Intermediate care is underdeveloped and has been identified as a critical element of the older persons care pathway. The HSE is committed to working with the DoH in re-allocating funding to increase intermediate care capacity, i.e. step-up / step-down beds, and to maximise community services such as Home Care Packages. This should reduce demand on acute hospital services and prevent inappropriate admissions to long-term residential care. 2012 is European Year for Active Ageing and Solidarity between Generations and we will work closely with the DoH to promote this agenda and to progress the recommendations of the National Positive Ageing Strategy when published.
The National Service Plan has identified the following priorities for 2012: . Centralise the administration of the Nursing Homes Support Scheme. . Provide quality long term residential care services for older persons who can no longer be maintained at home, in line with available funding under the Nursing Homes Support Scheme. This budget capped scheme will support 23,611 clients in 2012, an increase of 1,270 on 2011. . The challenges associated with the continued provision of residential care in public facilities as a result of staff reductions and the National Standards for Residential Care Settings for Older People in Ireland will lead to a continued reduction in the numbers of public beds in 2012. In the absence of reform, this would increase the cost of caring for older people within the public system, undermine the viability of public community nursing units, and reduce the overall number of older persons that can be supported within the budget available for NHSS. It is anticipated that a minimum of 555 residential beds will close in the course of the year. The majority of the beds identified are based on consolidation and reduction of public bed capacity in Public Long Stay Units. The number of actual units proposed to be closed will be kept to a minimum but will be as a result of the need to maximise value and sustainability through the consolidation of units. A decision to close a unit will only be taken following an extensive consultation process with the clients and staff of the identified long stay units. . Work closely with the Clinical Strategy and Programmes Directorate in the development of the programme for older persons. . Continue to improve the quality of home care services being delivered by implementing the National Quality Guidelines for Home Care Support Services. Following the completion of the national tender for Enhanced Home Care Packages, ensure standard implementation and monitoring of the approved providers. . Provide the supports required for older persons to live independently, in their own homes, for as long as possible through the use of high quality home support services targeted at those in need of support for personal care. . Respond to referrals of allegations of elder abuse in a timely and appropriate manner, in line with Protecting Our Future. . Progress the Single Assessment Tool to determine patient / client need, and ensure equitable access to services based on this need.
HSE South 57 OLDER PEOPLE’S SERVICES
Model of Care With the development of integrated care processes across hospital and community there is a need to ensure that older people with complex care needs are supported appropriately through the developing PCTs and with appropriate access to specialist care by way of Consultant Geriatrician input. Overall there is an increase in the levels of dependency of older people living at home and receiving significant and multi disciplinary service levels. This is leading to an increase in shared care arrangements across hospital and community and such a model of integrated care requires that all components are well coordinated and provide the older person in need of such care with an appropriate pathway to support their choices and needs. This will be the focus of the emerging clinical programme for older people services.
The ongoing roll out and development of the integrated model of care is ensuring that the various options within residential care, particularly in relation to rehabilitation and convalescence will be best utilised, to ensure that they provide value for money and that those in need of such services receive them as a matter of priority.
While there will always be a need for older people to access acute hospital care it is vital that once the acute episode has been addressed, they can access the appropriate service at home or by way of rehabilitation etc to ensure that they can maintain or improve their level of independence.
The requirement for access on referral to specialist medical services including consultant geriatricians or consultants in the psychiatry of old age is crucial to supporting older people to stay at home in their community for as long as possible and also for supporting the decision making process in relation to the need for the older person to access residential care. The developing primary care teams will need access to such specialist services to provide diagnosis and guidance with treatment for the older person.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Service Quantum In 2012 we will: . Provide 3.62m home help hours (4.5% reduction on 2011 outturn). Home Help service provision will be reviewed using the following criteria No current recipient of home help service who has an assessed need for the service will have it fully withdrawn The review will try to ensure that recipients who receive assistance with personal care needs are prioritised and that any reduction of service will be in the lesser priority area of household duties The home help service will be available to new recipients who have a requirement based on assessed need and within the available resources Some recipients may have the level of home help service increased rather than reduced . Maintain approximately 15,000 clients in receipt of home help services . Maintain existing levels of home care package services – target of 2,425 people . Provide over 7,600 day care places in 75 day care centres . Maximise the reorganisation of rostering, reduction in overtime and agency, and increase skill mix and other measures . Provide over 2,100 public residential care beds in 40 units (including the new Tralee CNU) providing long stay beds and short term respite, rehabilitation and convalescent care. Having regard for the NSP 2012 and the provision of public residential care for older people predominantly, each of the 4 Areas across the HSE South has undertaken a comprehensive assessment of capacity and resource availability associated with this service for the coming year. The areas undertook the review based on a number of factors : Demand for beds particularly choice of care by applicants for long stay beds through the Nursing Home Support Scheme ( Fair Deal) process Estimated number of retirements of care staff to end of February 2012 and to year end Cost of care in the unit and the potential / need to economise through roster changes and skill mix adjustments Audit of compliance of each unit with current and future HIQA environmental standards and in particular Fire Safety Standards and Legislation Review of HIQA inspection reports by unit to identify improvements required to meet standards particularly care related issues Cost of level of agency/cost containment and requirements for 2012 HSE South 58
OLDER PEOPLE’S SERVICES
% occupancy of all public beds ( long stay and community supports) and profile and trend of patient use of these beds
Following the analysis and based on the above criteria it is the intention in HSE South to retain the existing 39 public residential units and to open an additional unit in Kerry in 2012, providing a capacity of over 2,100 beds across these 40 facilities.
This would see a reduction of 128 beds from the position at the beginning of the year when there was 2,273 beds available. However, there is potential to have additional capacity available in Cork and Kerry with the opening of Tralee CNU and the full operation of Heather House, Farranlea Road and Ballincollig CNU in Cork.
In addition, in relation to the provision of welfare homes it is proposed to close 10 welfare home type beds in St. Francis Welfare Home Fermoy with the staff in this facility being relocated to Fermoy Community Hospital thereby ensuring no bed closures in Fermoy Community Hospital in 2012. As part of this proposal consideration is being given to the development of an Alzheimer’s day service on a two day week basis while also continuing to develop the use of the building for community based services. A consultation process will commence immediately in relation to this proposal.
Cost Management & Employment Control Measures The budget reduction for older people services in the South amounts to €8.959m which represents a 4.5% reduction. The cost management measures necessitated by the reduced funding available for older people services in 2012 are summarised below. Every effort will be made to ensure that the impact on services is minimised i.e. We will maximise the reorganisation of rostering, reduction in overtime and agency, and increase skill mix and other measures where appropriate, to limit impact on frontline services . Reduce Home Help Hours – 4.5% reduction on 2011 outturn. This represents a reduction of 170,000 hours - This reduction in hours will lead to a refocusing of the service towards patient care activity and essential domestic duties. . Public Residential Beds: Following the comprehensive assessment undertaken utilising the criteria outlined above, the position in relation to bed closures in HSE South has been revised downwards from a proposed minimum figure of 180 to a minimum reduction of 128 public residential care beds with a maximum of 210 in 2012. The successful implementation of our change programme and implementation of the model of care for older people will be a critical factor in enabling HSE South to minimise the impact on public long stay bed provision and full cooperation will be required from all stakeholders if this is to be achieved.
An important factor in the overall consideration of residential care bed closures was the fact that 101 of the 128 beds proposed for closure are currently vacant due to the demand for the Nursing Home Support Scheme, HIQA environmental standards, staff retirements etc.
Initial details of bed closures are set out below:
Carlow/Kilkenny & South Tipperary: 60 bed closures Cork: 22 bed Closures St. Columba’s Hospital (26 beds) Kanturk Community Hospital – 8 beds Sacred Heart Hospital (14 beds – includes 4 respite Midleton Community Hospital – 14 beds beds to relocate to Carlow District Hospital) Carlow District Hospital (10 beds) Castlecomer District Hospital (10 beds)
Waterford/Wexford: 15 bed closures Kerry: 31 bed closures New Houghton Hospital (2 beds) Listowel Community Hospital (17 beds) Dungarvan Community Hospital (13 beds) Loher / Dinish Ward, Kerry General Hospital (3 beds) St. Columbanus, Killarney (11 beds)
Waterford St. Patrick’s Hospital: 6 short stay beds were closed in St. Patrick’s in Waterford city in October 2011 and these will be reopened on a phased basis in Q1 2012 Dungarvan Community Hospital: 16 short stay beds were closed in Dungarvan in October 2011. Funding is being provided by HSE South to enable these beds to be reopened on a phased basis in Q1 2012 which is in line with the national policy direction and the overall needs of the area. The overall package will involve the redeployment of 7 staff from WRH to Dungarvan to support the opening of the beds.
At the same time, as a result of staff retirements in Dungarvan due to the grace period etc. it will be necessary to reduce the number of long stay beds provided by 13 beds. This will be achieved through the reorganisation of existing services in Dunabbey House and an overall reorganisation of the beds in
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OLDER PEOPLE’S SERVICES
the area. This shortfall in long stay beds will be compensated over the coming months with the opening of private nursing home beds in Waterford.
To ensure that this overall change is implemented in the most effective manner a specific review of bed usage, required designation and the potential to transfer resources across the service will be undertaken to determine the actual number and type of beds that will be provided in public facilities in the area during 2012. This review will be completed by the end of Q1 2012.
Carlow/Kilkenny There are a total of 60 temporary bed closures in the Carlow/Kilkenny area at present - the majority of these beds have been closed for an extended period of time. The existing number of beds continues to meet the demand for both short and long stay care. While the demands placed on the service through staff retirements will be considerable, existing service levels will be maintained through the development of efficient rostering systems and a skill mix model that will continue to meet the needs of older people in care. A continuous review of bed usage will be undertaken to ensure that the current mix of short and long stay beds is appropriate to meet the service needs and this mix may be amended as required.
Kerry West Kerry Community Hospital: Currently there are 6 temporary closed beds of the total number of 46 in the hospital, the beds are closed due to staff retirements. A change of rostering arrangements is required and with some additional nursing resource provided through redeployment, it is the intention to reopen all of the 46 beds by end of Q1 2012, matching the level of demand.
Listowel Community Hospital: The overall bed numbers in LCH are currently at 36 with an overall reduction of 17 beds from the original 53. Following a change of roster and adjusting the skill mix arrangements there is potential to reopen some of the 17 beds in the hospital.
Killarney Community Hospitals (incl. St Columbanus Home): The reduction in the overall bed number of 11, will see 135 beds remaining in place across the two sites. The 11 beds have been temporarily closed for a number of months, and the current bed numbers remaining match the demand for long stay beds in particular. Though there are a significant number of retirements, resources have been concentrated in the service to minimise bed closures, as the roster arrangements and skill mix measures have been deployed successfully in previous years.
Cork Clonakilty Community Hospital: Provision was made in the 2011 service plan for the closure of 16 beds in Clonakilty Community Hospital as part of the overall reorganisation of services in the hospital and having regard to the demand for beds under the Nursing Home Support Scheme. These 16 beds are currently vacant in the hospital and it is intended that these beds would close permanently in 2012. The remaining beds will be reorganised in a more efficient manner supported by a more effective roster arrangement thereby maximising overall service delivery within the hospital and in other public residential care facilities in the vicinity. St. Finbarr’s Hospital, Cork: A significant transfer of residential beds is being undertaken from the unit as part of the opening of the Farranlea Road CNU - to be completed by March 2012. A review of the remaining services in St. Finbarr’s Hospital will also be undertaken. There will be consolidation of the remaining bed numbers in the hospital and the overall bed capacity will be finalised in this context. This may see an overall reduction of bed numbers at St. Finbarr’s Hospital. . Welfare Home Beds: St. Francis Welfare Home, Fermoy: A consultation process will be undertaken with regard to the future of the residential care services at St. Francis Welfare Home with a proposed closure of 10 welfare home type beds in this facility and the staff being relocated to Fermoy Community Hospital thereby ensuring no bed closures in Fermoy Community Hospital in 2012. As part of this proposal consideration is being given to the development of an Alzheimer’s day service on a two day week basis while also continuing to develop the use of the building for community based services. A consultation process will commence immediately in relation to this proposal. . Revision of rosters and skill mix across Community Hospitals based on a standard model approach - work will be undertaken with the Directors of Nursing to review rosters and skill mix etc. in order to minimise the impact of the moratorium and the reductions in agency usage necessary to operate within available resources. Where changes to rostering arrangements etc. are required, a consultation process will be undertaken with staff representative associations involved under the terms of the public service agreement. . Reduction in Voluntary Agencies funding – voluntary agencies will be required to identify and implement efficiencies and economies to ensure service provision is maximised and prioritised. . Efficiencies to be achieved in the following areas: Aids and Appliances and multi disciplinary supplies – maximise the available resource through prioritising provision, availing of all opportunities to procure products as cheaply as possible without
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OLDER PEOPLE’S SERVICES
compromising on quality and through careful management of recycling of stock, reviewing criteria and procedures for provision of some items etc. Nursing Supplies e.g. reduce the cost of supplying incontinence products to Nursing Homes based on a review of procedures, pricing etc. Initiatives in relation to the management of wound care and optimisation of appropriate use of dressings
Service Improvements . Roll out of Home Care Package approved provider list of voluntary and private home care providers which will introduce clear national minimal standards for the delivery of home care services as part of a home care package. . Establish regional office for the processing of applications for the Nursing Home Support Scheme – this will assist applicants for the scheme through the provision of information, up date on progress of the application process etc. for the four areas in HSE South. . Implement National Home Help Guidelines which will introduce a standardised and consistent approach to the delivery of home help services . Occupational Therapy Project in Dementia Care working in collaboration with carers and the Alzheimer’s Association in Cork . Establish regional group to review rosters and skill mix in public residential units so as to ensure that the services provided are optimised to meet the needs of the residents. This group will be chaired by a member of the Regional Management Team and its work will include the review of beds planned for the Waterford Area and St. Finbarr’s Hospital, Cork
Improving our Infrastructure . Capital projects that are to be completed and / or to become operational in 2012 Phased opening (from December 2011) of Farranlea Road Community Nursing Unit, Cork Heather House and Ballincollig Community Nursing Units, Cork to be fully operationalised. Opening of Tralee Community Nursing Unit, Kerry Kenmare Community Hospital, Kerry – ongoing construction of 40 bed community nursing unit which commenced in Nov 2011
Key Result Areas The following Key Performance Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Nursing Homes Support Nursing Homes Support Scheme (NHSS) – A Fair Deal Scheme – A Fair Deal Full utilisation of NHSS – A Fair Deal within the funding allocated under Subhead B12 Ongoing . Support 23,611 clients under NHSS in 2012 (based on an average of public bed Q4 closures) Centralise administration and financial management of the scheme in a central national Q2 office (CNO), including the National Placement List . Business Case for NHSS Centralisation completed. From January 1st 2012, block Q1 funding for public long stay residential beds will cease . A system will be developed to fund public long stay residential care on a named Q1 patient / occupied bed basis . Implementation of this new funding system Q2 Participate in the substantive DoH review of the scheme Q4 Public Care Settings for Provide an agreed level of public long term residential beds Ongoing Older People Reconfiguration / rationalisation / closure of a minimum of 555 beds to occur in 4 regions Ongoing as follows: . DML = 111 . DNE = 105 . South = 180 . West = 159 Please note the figures referred to above are proposed bed closures only, and include a small number of units for closure. However, any decision to close a unit will only be taken following an extensive consultation process with the clients and staff of the identified long stay units. HSE South HSE South 61
OLDER PEOPLE’S SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter . The figure of 180 proposed bed closures in the NSP was based on preliminary estimations of staff numbers retiring and on a broad assessment of potential service reduction. The regional service plan figure of a minimum closure of 128 beds is based on more up to date information on numbers retiring, and on ongoing negotiations with regard to alternative rostering arrangements in key locations which has reduced the overall number of bed closures estimated. Efficiency Examine skill mix to ensure appropriate staffing is provided to meet needs of residents by Q1 reviewing current Skill Mix Configuration and Human Resource Deployment in HSE Care Units in line with Regional reconfiguration objectives, and make recommendations inclusive of best practice and cost effectiveness Examine elements of cost of long term residential care in HSE Care Units e.g. rostering Q2 arrangements Older People Clinical Reconfiguration of Public Residential Facilities Programme Review and determine short term bed requirements for rehabilitation (< 12months) / Q2 respite, short stay, step up / step down and assessment Identify, within public bed stock, number of beds that can be converted to meet short term Q1 bed requirements Service Model Work with the clinical programmes and consultant geriatricians to develop a geriatric Q2 service model Community and Home Intermediate and Home Care Supports Identify and implement innovative models of care for people requiring intermediate and Ongoing home care with a view to preventing inappropriate admissions to acute hospitals / long term residential care and addressing delayed discharges, etc. in a more timely way Home Care Complete the National Quality Guidelines for Home Care Support Services Q1 Implement on a phased basis Ongoing Home Help Service Complete the National Home Help Guidelines and implement on a phased basis Ongoing Implement regular reviews of home help clients to ensure optimal use of available resource Q2-Q4 Examine home help delivery model with a view to value for money (VFM) and service Ongoing improvement Home Care Packages Undertake reviews of home care package clients to ensure optimal use of available Ongoing resource Finalise and implement the procurement process for home care packages Q1 Ensure regional governance of implementation of Approved Provider Panel Ongoing Legislative Framework – Community Services Continue to work with DoH on legislative proposals for community services Q4 Provision of equitable ancillary care / aids and appliance services to all older persons Complete work of National Ancillary Group to put in place standardised processes around Q3 the delivery of these services to both the community sector and the residential sector within available resources Develop protocol for access to ancillary services for older people in designated centres Q1 Keep Older People Healthy Work with DoH in developing National Positive Ageing Strategy and, when published, in Q4 and Out of Hospital implementing the recommendations Work with DoH towards promotion of European Year for Active Ageing and Solidarity Ongoing between Generations Work with DoH on development and roll out of Dementia Strategy Q4 Select four demonstration sites and complete the planning phase of the HSE / Genio Q2-Q3 Dementia Project to outline community based supports and commence implementation Work with the Ageing Well Network in the national development of Age Friendly counties Ongoing Liaise with the primary care service to ensure the identified needs of older people are met Q4 through the PCTs, Primary Care Networks and Community Intervention Teams Implement (on a phased basis) recommendations from the Strategy to Prevent Falls and Ongoing Fractures in Ireland’s Ageing Population, with the primary care service and the Clinical Strategy and Programmes Directorate Complete procurement process for the Telecare project to support for older people at home and implement Q1-Q2 HSE South 62
OLDER PEOPLE’S SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter Elder Abuse Protection of Older People – Protecting Our Future . Provide a timely / appropriate response to allegations of elder abuse in line with Ongoing agreed performance measures . Review all referrals of abuse at least six monthly Standardised Assessment in Single Assessment Tool (SAT) Community and Acute Conclude pilot SAT and analyse findings Q1 Settings Prepare business case for consideration Q2
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South Home Care Packages* Total no. of persons in receipt of a HCP 2,345 2,425 2,425 No. of HCPs provided 1,304 1,304 1,304 No. of new HCP clients 1,000 1,184 1,100 Home Help Hours No. of home help hours provided for all care groups (excluding provision 3.9m 3.79m 3.62m of hours from HCPs) No. of people in receipt of home help hours (excluding provision of hours 14,700 15,681 15,053 from HCPs) Day Care No. of day care places for older people Baseline to be set National survey undertaken Targets to be Q4 to inform 2012 targets determined NHSS Baseline to be set 6,157 Centralised scheme in No. of people being funded under NHSS in long term residential care at 2012 - end of reporting month 23,611 No. and proportion of those who qualify for ancillary state support who Baseline to be set 1,004.8 Demand-led chose to avail of it % of complete applications processed within four weeks 100% 100% 100% Subvention and Contract Beds No. in receipt of subvention Dependent on uptake of 320 275 NHSS No. in receipt of enhanced subvention Dependent on uptake of 240 220 NHSS No. of people in long-term residential care who are in contract beds New PI for 2012 New PI for 2012 To be reported in 2012 No. of long stay residents in public and voluntary nursing homes admitted New PI for 2012 New PI for 2012 To be reported in 2012 before 27 Oct 2009 (saver cases) Public Beds No. of beds in public residential care setting for older people 2,300 2,420 2,170-2,240
Elder Abuse No. of new referrals by region Demand-led 574 770 No. and % of new referrals broken down by abuse type: i). Physical Baseline to be set 75 --- ii). Psychological Baseline to be set 188 --- iii). Financial Baseline to be set 130 --- iv). Neglect Baseline to be set 111 --- No. of active cases New PI for 2011 803 --- % referrals receiving first response from senior case workers within four 100% 100% 100% weeks *The outturn for the number of new HCP clients for 2011 includes additional clients funded under the €8m new development funding and clients approved following implementation of the new standard definition for HCPs in 2011. Therefore the number of new clients for 2012 is expected to be 4,800 overall and is based on turnover within existing funding.
HSE South 63
Mental Health Services
Introduction The mental health of the population plays a vital role in the vibrancy and Resources economic life of the country. Therefore, investing in promoting positive FINANCE – HSE SOUTH mental health and in early intervention is not only an investment in the individual’s quality of life but also in the global health status of the nation. 2011 2012 Area Budget Budget €m €m The HSE is required to deliver its mental health services within a decreasing budget and headcount. Our mental health services include a Cork 75.514 70.660 broad range of primary and community services as well as specialised Kerry 22.191 20.743 secondary care services for children and adolescents, adults, and older Carlow /Kilkenny/Sth Tipp 52.428 49.078 persons. In recent years there has been increased specialisation, including Waterford/Wexford 37.361 34.942 rehabilitation and recovery, liaison, forensic, mental health services for Total 187.494 175.423 people with an intellectual disability, and suicide prevention initiatives. Services are provided by the HSE and voluntary sector partners in a WTE Ceiling – HSE SOUTH number of different settings including the service users’ own home, acute Dec 2011 Projected Area inpatient facilities, community mental health centres, day hospitals, day Dec 2012 centres, and supported community residences. Cork 1,026 994
Kerry 314 305 Guiding the development of our services is A Vision for Change – a progressive, evidence-based and pragmatic policy document, which Carlow /Kilkenny/Sth Tipp 777 753 proposes a new model of service delivery designed around the service Waterford/Wexford 494 478 user, one that is recovery-orientated and community-based. A Vision for Total 2,611 2,530 Change is strong on values and sets out a comprehensive change programme for our mental health services. When published, it included a number of very significant commitments on infrastructure, new revenue funding and new multidisciplinary staff (+ 1,800). Since A Vision for Change, the HSE has spent €190m on mental health capital and has further contracted commitments of €57m. The multi annual capital plan also shows non-contracted but planned spend of a further €170m. That means that a total of €417m of investment will be made. This does not include the community facilities that have been acquired under the primary care centre lease programme (estimated equivalent value to date €20m). In that period there has been a total of €37m from sale of lands. A Vision for Change states “the value of these assets significantly counterbalances the cost of the new mental health service infrastructure requirement”. This has very clearly not been the case, however the full capital investment required in A Vision for Change has been met.
Notwithstanding the reduction in budgets and staff numbers across the service in 2012, in line with the Programme for Government, the Minister of State with responsibility for Mental Health has ring fenced €35m nationally for investment in mental health services. This funding has been made available to enhance General Adult and Child and Adolescent Community Mental Health Teams, improve access to psychological therapies in primary care and implement suicide prevention strategies in line with Reach Out – National Strategy for Action on Suicide Prevention. Approximately 400 extra staff will be recruited to support this. In addition, a number of inpatient child and adolescent units will open in 2012 which have for a long time been a critical gap in the spectrum of mental health services. Within the additional €35m, €2m will be allocated to Genio projects. A national process has been put in place between the HSE, The DoH and the Minister’s office to oversee the allocation of the resource, from which it is anticipated that an appropriate allocation of the funding will be provided to HSE South to support the overall change programme being implemented in line with Vision for Change and which also will assist in addressing gaps in service that may have arisen. This funding will assist in mitigating the impact of the overall budget reductions including reductions arising as a consequence of the impact of the efficiency, procurement and moratorium savings which will be applied.
The cumulative impact of staff loss from the mental health services since 2009 and the attrition expected in early 2012, continues to challenge us to provide continuity of services to our patients and clients. It will however support us in expediting our strategic reform programme with the closure of old psychiatric institutions and associated inpatient beds. There will also be reductions in payments to external agencies who will be challenged to maximise efficiencies.
HSE South is fully committed to utilising the provisions of the Public Service Agreement to deliver better health outcomes in a more cost efficient service delivery model. We will reorganise existing resources to achieve the optimal match between staffing levels, service activity levels and dependency levels across the working day/week/year.
HSE South 64 MENTAL HEALTH SERVICES
The National Service Plan has identified the following priorities for 2012: . Promote positive mental health and prioritise suicide prevention; in particular, implement outstanding actions in Reach Out – National Strategy for Action on Suicide Prevention. . Strengthen General Adult Community Mental Health Team (CMHT) capacity by ensuring, at a minimum, that at least one of each mental health professional discipline is on each general adult community mental health team. . Strengthen Child and Adolescent Community Mental Health Team (CAMHT) capacity by ensuring, at a minimum, that at least one of each mental health professional discipline is on each team. . Maintain and increase child and adolescent acute inpatient capacity. . Continue to review the number and location of acute and continuing care beds so as to rationalise inpatient provision. . Continue to work with all stakeholders to plan for the closure to admissions to the traditional psychiatric hospitals. . Develop the capacity to effectively manage mental health needs appropriate to a primary care setting. . Ensure access to quality psychotherapy and counselling services for patients eligible under the general medical services within primary care. . Progress the project plan to relocate Central Mental Hospital to St. Ita’s, Portrane and progress associated national forensic infrastructure to include Forensic CAMHS Unit, Forensic Mental Health Intellectual Disability (MHID) Unit and provision of four Intensive Care Rehabilitation Units (ICRUs). . Implement agreed clinical care programmes in mental health. . Develop effective partnerships with voluntary and statutory agencies to deliver integrated care for service users. . Develop the service user and carer partnership by ensuring service user representation on Area Mental Health Management Teams.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Reorganisation of Mental Health Services in line with A Vision for Change Across the HSE South, Mental Health services are provided for people of all ages who need specialist assessment, care and treatment for mental illness. The priority for HSE South is to ensure the provision and delivery of a first class mental health service for all. The ‘Vision for Change’ National Policy document on Mental Health details a comprehensive model of mental health service provision for Ireland and in keeping with this policy direction, the HSE South plan for Mental Health Services includes a range of measures aimed at improving service user health, independence and experience and, at the same time, continuing to reorganise service delivery to ensure increased efficiency. In line with the modernisation and reorganisation of services envisaged in Vision For Change, HSE South continues to accelerate the programme of closure of old long-stay institutions, reduce dependency on inpatient beds and prioritise the development of community based Mental Health Services across the four areas.
In doing so, our strategic objectives are to:
. Support people’s recovery from mental illness so that they can gain as much independence as possible. . Continue to develop community-based services. . Provide access to appropriate primary/ community and secondary care services in a timely manner. . Work in partnership with service users, carers, primary care and colleagues both statutory and voluntary. . Advance the national and local governance arrangements. . Develop the workforce, buildings and information systems to support improved and cost-effective care and treatment.
HSE South is committed to ongoing consultation and engagement with all key stakeholders in relation to the development of Mental Health Services including service users and representatives, staff, and local representatives. Consultation and engagement will be ongoing in 2012 and will continue to be a critical element in the development and roll out of plans. Vision for Change advocates a move towards a recovery orientation: ‘A recovery approach to mental health should be adopted as a cornerstone of this policy’ (A Vision for Change, p. 15). This is where it recognises that the primary knowledge of mental health is with the service users and the secondary knowledge is supported by the providers. HSE South is committed to the development of a recovery orientation in the development of services. The promotion of positive mental health spans all life stages, and in conjunction with early intervention and treatment can facilitate improved outcomes. HSE South Mental Health
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Services include a broad range of acute, community and specialised inpatient services for children and adolescents, adults and older people.
Executive Clinical Directorate Model In line with VFC recommendations 4 Executive Clinical Directors (ECDs) have been appointed in the HSE South. They have been selected to lead on the development of Executive Clinical Directorates in Mental Health based on revised catchment areas serving populations of approximately 300,000 or more as recommended in Vision for Change. Within the mental health service, the change management role of Executive Clinical Directors and the related Clinical Directorate will provide a clear focus to drive service quality and the implementation of the recommendations of VFC. The ECD, with the Mental Health Management Team will bring leadership, governance and accountability in shaping the direction of the mental health services within the four areas in HSE South
HSE South Implementation of Vision for Change In planning the implementation of Vision for Change in HSE South there were significant challenges to be faced in the South East which required urgent reorganisation of the service both to meet the standards of Vision for Change, and to address the deficiencies identified in a number of key reports including the Section 55 Report, the Annual Reports of the Inspector of Mental Health Services and in ongoing engagement with the Mental Health Commission.
In this regard a decision was made to target the South East initially for development. This focus on the South East has resulted in significant levels of progress in the development of Implementation Plans for both Carlow / Kilkenny & South Tipperary and Waterford / Wexford and significant progress has been made to date in the implementation of these plans including the closure of beds in old institutions and transfer of patients to more appropriate settings, infrastructural developments, reduction in acute beds and development of community based services. Given the significant change process which has been undertaken it is important to acknowledge the progress which has been made as both areas are at an advanced stage in the implementation of Vision for Change.
It is important to acknowledge that in progressing the implementation of Vision for Change, choices have had to be made around the prioritisation of developments and in that context HSE South prioritised South Tipperary, Waterford and Wexford over other areas in the region as the need was greater there.
In particular the capital funding to date has been prioritised to these locations to support the change programmes in these locations and we have not had available to us the resources required to finalise the closure of St. Finan’s Hospital in Kerry or the development of community based infrastructure in South Lee. At the same time we have made progress across the whole region in terms of the development of teams and some key specialist services.
Reduction in bed complement in line with A Vision for Change A key priority for the HSE South has been to shift the model of care from the old long stay institutions to the development of a comprehensive community based service. This allows a shift in focus of the resources available which can deliver enhanced user outcomes. At the same time we have continued to focus on the reorganisation of acute inpatient services in line with Vision for Change recommendations. Progress is being made on all these fronts including:
. The transfer of the North Tipperary Acute Service from St. Michael’s Unit to HSE West was completed in October 2011. 20 beds closed in St. Michael’s unit in October 2011. . St Dympna’s hospital in Carlow closed its long stay beds in October 2011 with patients re- accommodated in other more appropriate settings according to their needs. . Closure of remaining long stay wards in St Canice’s Hospital Kilkenny. . Work is continuing to relocate the patients in St Luke’s, South Tipperary and with the completion of the CNU in March 2012 and the Community Residences in June 2012, St Luke’s will close as an approved centre. . Patients currently resident in St Senan’s Wexford will be accommodated in the new developments due to be completed in 2012 which include the development of a new CNU & a number of Community Residences. . St Finan’s hospital Kerry will no longer take direct admissions or transfers of patients from the acute unit at Kerry General Hospital. Long stay beds will continue to be reduced with the closure of a female ward and with 10 high dependency beds remaining within the main building. The female patients in the ward that is being closed will transfer to more appropriate accommodation either on site (O’Connor unit or community residences). . South Lee – St Monica’s ward in St Finbarr’s Hospital closed its 13 long stay beds. HSE South 66
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In respect of HSE South, Vision for Change recommendations in respect of acute inpatient beds of 50 beds per 300,000 population indicate a requirement of 193 acute inpatient beds for the South. At the beginning of 2011 we had 352 beds in place (159 above the recommended number). There are now 301 following the closure of acute beds in St Senan’s (31 in April 2011) and the reduction of beds in St Michael’s Clonmel (20 in October 2011). In 2012 additional bed reductions are planned so that services can be re-orientated towards the development of the community based model of service.
Development of Community Mental Health Facilities in Primary Care In the development of Primary Care Centres in HSE South facilities for Mental Health are being accommodated where required. This can be dedicated space in some Primary Care Centres or bookable rooms for visiting clinicians. Centres in a number of areas have been completed and Mental Health Services has dedicated accommodation in locations such as Mallow Primary Care Centre in Cork or Ayrfield Primary Care Centre in Kilkenny, the soon to be developed primary care centre in Kenmare and access to bookable rooms if required in locations such as Gorey Primary Care Centre.
Developments in the following areas are progressing and are at different stages of development: Macroom, Clonakilty, Fermoy, Charleville, Schull, Ballincollig, Blackrock, Listowel, Newmarket, Kilkenny, Callan, Waterford City, Dungarvan, Enniscorthy, New Ross, Tipperary, and Clonmel. As Centres are completed facilities for Mental Health services will be accommodated where required
Service User Involvement As part of the overall process the development of the service user role is a fundamental component of the model we are developing in the South. Formal arrangements have been put in place with the National Service Users Executive (NSUE) to develop a comprehensive framework for service user involvement over the next few years.
National Clinical Programmes Implementation of the new national approaches being developed under the leadership of Dr. Ian Daly and Mr. Martin Rogan, Assistant National Director Mental Health Services will support the delivery system with the implementation of Vision for Change. The implementation of such national programmes will assist the service in addressing service variability across each area as well as standardising our approaches and planned outcomes.
Service Quantum In 2012 we will provide: . 241 acute inpatient beds – reducing acute inpatient capacity in line with A Vision for Change norms through the reduction of 60 acute inpatient beds . 20 inpatient Child and Adolescent Mental Health beds . 317 long stay beds (and an additional 59 rehab beds and 29 low secure beds) representing a reduction of 62 beds . 709 residential places in low/medium/high support community residences representing a net increase of 41 places . 267 day hospital places representing an increase of 84 places due to developments in Carlow/Kilkenny/South Tipperary and Waterford/Wexford areas . 610 day centre places . 27 General Adult Community Mental Health Teams – including the newly amalgamated CMHTs in Carlow, Kilkenny and South Tipperary . 13 Child and Adolescent Mental Health Teams, 1 Liaison Psychiatry Team (CUH), 6 Community Rehabilitation Teams, 5 Psychiatry of Later Life Teams . Accommodate clients in more appropriate care settings. Staff released by the reorganisation will be redeployed to support the development of the community service including the filling of vacancies to agreed levels. This will place increased pressure on acute services which will have to be addressed by an investment in community based services through the additional resource now being provided.
Cost Management & Employment Control Measures in Mental Health Services The budget reduction for mental health services in the South amounts to €11.455m which represents a 6.1% reduction. There are 124 WTE staff who will leave the service in the context of the grace period 2012. In addition there are a range of cost management measures necessitated by the reduced funding available for mental health services in 2012 which are summarised below. Every effort is made to ensure that the impact on
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MENTAL HEALTH SERVICES services is minimised. We will be maximising the reorganisation of rostering, reduction in overtime and agency, and increasing skill mix and other measures to limit the impact on frontline services. . Staff rearrangements and rostering i.e: introduction of skill mix - this will see the appropriate use of trained health care assistants working closely with nursing staff in the provision of care to those dependent clients who require supported accommodation review rosters and staffing levels, reduce level of rosters, reduce reliance on institutional care by closure of long stay wards & high support hostels (outlined below) reduction in overtime and agency costs across all services. . Review of nurse management structures – replacement of Night Superintendant roles with enhanced role for frontline managers. . Review of staffing levels in high support hostels. Any hostels currently employing two nurses on a 24/7 basis . Targeting of nursing levels by day to meet needs of clients. . Introduction of standardised policies for ‘specialing’ clients who require additional attention. Ongoing review of these policies . The re-organisation of services in line with A Vision for Change will support the development of community services while at the same time reduce the overall cost of services, maximising the benefit to service users.
Acute Beds: reduction of 60 High Support Beds: reduction of 12 Kerry General Hospital, Tralee (6 beds) Caherciveen, (12 beds) St. Michael’s Unit, Clonmel (29 beds) Long Stay Beds: reduction of 10 Cork Services (25 beds) St. Finan’s, Killarney (10 beds)
Clients will be accommodated in more appropriate care settings. Staff released by these reductions will be redeployed to support the development of the community service including the filling of vacancies to agreed levels. This will place increased pressure on acute services which will have to be addressed by an investment in community based services through the additional resource now being provided. . Other Proposed Initiatives include efficiencies in overhead costs, voluntary agency spend, drugs expenditure etc.
Outline of 2012 Service Plan Priorities for Each Area
Carlow / Kilkenny & South Tipperary . Community Mental Health Teams (CMHTs) To support the major change programme underway within the Carlow/Kilkenny & South Tipperary area, there is comprehensive development of Community Mental Health Teams to meet the increased demand for community services. CMHTs bring together the key professionals to provide a range of mental health interventions for a defined community. Members of the core Community Mental Health Teams, the Home Based Treatment Teams and the Acute Day Services (Day Hospital) will work in close collaboration to provide a comprehensive community based service. Six allied health professionals will be appointed to Carlow / Kilkenny & South Tipperary area to support the development of community mental health services.
South Tipperary: The process of amalgamating the three existing CMHTs for Clonmel East, Clonmel West and Cashel into one team commenced on 31st October 2011. A Team Coordinator (as described in a Vision for Change) was appointed on 7th November 2011 to facilitate this amalgamation and to support the continued development of comprehensive Community Mental Health Teams with one point of access.
A significant milestone will be achieved when the Clonmel East and Clonmel West Community Mental Health Teams will co-locate with the new Acute Day Hospital in Clonmel in May 2012. The existing team base for Cashel/Tipperary CMHT will be maintained at Carrig Oir, Cashel.
Carlow / Kilkenny: The amalgamation of the two existing CMHTs in Carlow (Carlow North and Carlow South) commenced on 31st October 2011. A Team Coordinator (as described in a Vision for Change) was appointed on 7th November 2011. A further development will be achieved when the CMHT co-locates with the Acute Day Service/Home Based Treatment Team in June 2012 in a facility on the grounds of St. Dympna’s Hospital, Carlow which is currently being refurbished.
The process of amalgamation of the three existing Community Mental Health Teams in Kilkenny (Kilkenny East, Kilkenny West and Kilkenny North) commenced on 31st October 2011. A Team Coordinator (as described in a Vision for Change) was appointed on 7th November 2011. The HSE South 68
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Community Mental Health Team will co-locate with the Acute Day Service/Home Based Treatment Team in an existing modern facility on the grounds of St. Canice’s Hospital in May 2012.
. Acute Day Services (Day Hospital) The Acute Day Services (Day Hospital) are community services that offer an alternative to inpatient admission for a proportion of service users. Best practice indicates that acute day services (day hospital) facilities are suitable for a quarter to a third of service users who would otherwise be admitted to hospital.
South Tipperary: Development of 2 new Acute Day Services (Day Hospital) in Clonmel and Cashel. The acute day services (day hospital) for Cashel became operational in Carrig Oir, Cashel on 31st October 2011
On the same day, acute day services (day hospital) for Clonmel was established in a temporary location in a refurbished building on the St. Luke’s Hospital campus. Construction has commenced on the permanent location for the Day Hospital and CMHT Base in Clonmel, on the St Luke’s Hospital campus and is on schedule for completion in May 2012.
Carlow and Kilkenny: The focus in Carlow has been to enhance the existing acute day services (day hospital) on the grounds of St. Dympna’s Hospital, Carlow. This is currently operational on a seven day week basis. Staffing at the existing Day Hospital in Carlow was enhanced during October/November 2011 following the closure of St. Patrick’s Ward.
The current five day services at St. Canice’s Hospital Kilkenny are being extended to provide a seven day service from 28th February 2012. In the interim the Acute Day Services (Day Hospital) will continue to be provided from the current location in St. Canice’s Hospital. Staffing at the Acute Day Services (Day Hospital) has been enhanced following reorganisation of hostel services.
. Home Based Treatment Teams (HBTTs) HBTTs are part of the amalgamated and enhanced community mental health teams and as such are consultant-led multidisciplinary teams, providing a seven day service, which will enable service users to receive treatment in their own home. South Tipperary: The HBTT for South Tipperary became operational on 31st October 2011 with the redeployment of staff from St. Michael’s Unit following the transfer of 20 acute inpatient beds for North Tipperary service users to the HSE Mid West. The Home Based Treatment Team for South Tipperary is now operating on a seven day basis, with agreement to implement the on-call facility on the 26th February 2012. This enables service users to receive treatment in their own home environment and is providing an important alternative to acute inpatient care.
Carlow Kilkenny: The two Home Based Treatment Teams one for Carlow and one for Kilkenny became operational from 31st October 2011. The redeployment of staff to these teams has facilitated the development of an important alternative to acute inpatient care.
. Crisis/Respite Accommodation Respite accommodation will be used for crisis accommodation and acute respite purposes for up to 72 hours. It will offer alternatives to inpatient care for a proportion of those who would otherwise have been admitted to the acute hospital setting.
South Tipperary: Another important element of the development of South Tipperary services will be the opening of a crisis / respite facility which will be provided at the Edel Quinn House, which will be a temporary location while the permanent facility is being built. This is a nine bedded facility on the grounds of St. Luke’s Hospital, Clonmel. This facility will be used for crisis accommodation and acute respite purposes. It will offer alternatives to inpatient care for a proportion of those who would otherwise be admitted to hospital. The Edel Quinn building will be available to commence the crisis / respite service from the end of March 2012. The staffing for this facility will be provided following the redeployment of staff on the closure of St. Michael’s Unit.
The permanent building will be constructed in Clonmel and tender documentation for the selection of the design team will be issued on the 13th February 2012.
Carlow/Kilkenny: Respite accommodation services for Carlow / Kilkenny will continue to be provided in a 12 bedded unit at Greenbanks Hostel, Carlow.
. Continuing Care & Accommodation Services Community Nursing Unit (CNU) To facilitate the closure of the old inappropriate long-stay facilities at St. Luke’s Hospital, Clonmel and the relocation of over 40 residents and the related staffing and resources, a new purpose built CNU is currently under construction on the St. Luke’s Hospital Campus, Clonmel. HSE South 69
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The CNU will open in March 2012 and residents and staff from St. Paul’s and St. Mary’s Unit in St. Luke’s Hospital will transfer to this new premises. As part of this process, the Mental Health Commission requires a reduction of 40 in the number of residents that can be accommodated in St. Luke’s Hospital, Clonmel by June 2012. For an initial short transition period, the CNU will be registered under the Mental Health Commission (MHC) with the intention of transferring to full HIQA registration in respect of Services for Older People at an early date. The arrangements in this regard will be agreed with MHC and HIQA in line with normal procedure.
. High Support Services A comprehensive review of all residents in hostels/support accommodation in the Carlow/Kilkenny & South Tipperary area has been ongoing in 2011. The purpose of this review is to assess residents accommodation needs with a view to providing more independent living accommodation if appropriate.
South Tipperary: The remaining patients in St. Luke’s Hospital, Clonmel (St. Teresa’s Unit) will transfer to a newly built High Support Hostel in Clonmel in June 2012. This will be a 12 bed facility supporting the delivery of a community orientated service. Following this transfer, St. Luke’s Hospital Clonmel will be closed in line with the recommendation of the Mental Health Commission.
. Acute In-Patient Provision As community mental health services are further developed in the Carlow/Kilkenny & South Tipperary Area, those with mental health needs will be able to avail of more appropriate services in the community with fewer people requiring admission to hospital.
The 44 bed acute in-patient unit in St Luke’s General Hospital, Kilkenny which fully meets all the requirements as set out in “A Vision for Change” will be the designated approved centre for the Carlow, Kilkenny and South Tipperary Area. This will enable all acute admissions to be managed at a single site. The acute bed allocation in the in-patient unit in St. Luke’s General Hospital, Kilkenny is currently being reorganised to accommodate admissions from South Tipperary.
The development plan for the area indicated that as this change programme is progressed, and community based services are fully implemented, the acute inpatient beds in St. Michael’s Unit will no longer be required and it will close as an approved centre. The intention is that all the community based services will be in place by end of March 2012 and this is the target date for St. Michaels to close. No services will cease until alternative community based services are in place.
This target date will be kept under close review through the governance framework within the HSE, with the Mental Health Commission and DOH to ensure quality and safe outcomes at all times.
The remaining staff within St. Michael’s Unit Clonmel will be redeployed to support the staffing of the Crisis House, Home Based Treatment Teams and the Acute Day Services (Day Hospitals) in Clonmel and Cashel.
Wexford & Waterford . Re-organisation of Sector Teams – Adult sector teams provide services to the area - including South Kilkenny. These have been initially re-organised from 6 sectors into 4 and a half large sectors to accommodate operationalising this system of patient management with eventual progression to five sectors. These sectors are Waterford West based between Dungarvan and Tramore. The Tramore service will commence in Q2 2012 in a Primary Care Centre. Waterford City is based in Brook House which has been renovated and will open in Q1 2012. Waterford City also provides services to South Kilkenny. Wexford South with 7 day services in Wexford in Summerhill and 5 Day services in Maryville, New Ross. Summerhill is currently being refurbished to be completed in Q2 2012. Wexford North has two 7 day services in Gorey, Tara House and Enniscorthy, CARN House. These centres provide Day Hospital services to each sector. . Building of Community Nursing Unit named Farnogue Healthcare Centre commenced - completion date Q3 2012. The purpose of this unit is to decant an elderly care ward from St. Senan’s Hospital, Enniscorthy and to provide a new base for the Wexford Mental Health Psychiatry of Later Life Team. It will be based on the grounds of Wexford General Hospital. . A key project in 2012 to advance the closure of St. Otteran’s Hospital will be the closure of St. Monica’s Ward which is a 27 bed long stay elderly ward and to resettle residents appropriately back to the community including nursing homes, community residences and other mental health facilities. It is expected that this will release a number of nursing staff for redeployment to enhance community services including the Day Hospitals in Brooke House, Dungarvan and Tramore. Brooke House will then operate a 7 day Day Hospital service. Expected completion date Q4 . Tus Nua commenced services in Q4 2011 and will continue to provide services for the Rehabilitation Team in Wexford HSE South 70
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. Three High Support Residences are currently under construction and due for completion in Q4 2012. These are : Havenview, a twin unit of 14 beds which will enable the relocation of St. Christopher’s Ward from St. Senan’s Hospital, Enniscorthy. Havenview will provide care to people with severe to profound Intellectual Disability. Millview, a 12 bedded unit which will enable the relocation of St. Enda’s Ward from St. Senan’s Hospital. Millview will be a high support residence under the care of the Rehabilitation Team – Underway due for completion end of 2012. . In 2011 acute services were closed at St. Senan’s Hospital and centralised in the Department of Psychiatry at Waterford Regional Hospital for the area. The department in Waterford is a 44 bedded unit and is currently being refurbished to provide enhanced facilities. This will be completed by Q4. . Following the closure of the remaining mental health units at St. Senan’s Hospital remaining staff both clinical and non clinical will be redeployed to augment day hospital and residential services. . In Q4 2011 Psychiatric Liaison Services commenced in the Emergency Department in Waterford Regional Hospital and the full year benefit of these services will be derived in 2012. . Development of a Respite House in Enniscorthy to commence Q4 to provide 10 beds for respite care for Waterford/Wexford. . A consumer panel has commenced for Waterford/Wexford with 18 service user members with the support of National Service Users organisation and this initiative will be further enhanced in 2012 . The management team for Waterford and Wexford Mental Health Services have merged to form one management team for Waterford/Wexford.
Cork Mental Health Services in Cork will be expediting the implementation of Vision for Change in 2012. This will commence with the establishment of a Project Implementation Group representative of all stakeholders to determine how the service will change to focus on a recovery and community based model of service delivery in Cork. This project implementation group will be provided with an overview of the work undertaken to date by a multidisciplinary group of clinicians and managers across all mental health services in Cork. The group will report by the end of the first quarter with the intention of proceeding with implementation on a phased basis over the reminder of the year.
In 2012, access to services in the community will be enhanced through reorganisation of acute inpatient services and reassigning staff from acute inpatient units to enhance community mental health teams, day hospitals and home treatment and assessment services. To achieve this, consistent with Vision for Change, inpatient services in North Lee and North Cork will be consolidated with a phased reduction of 25 beds. As part of this consolidation, the respective requirement for inpatient beds between Cork North and South Lee / West Cork will be reviewed with the potential for some specialist services to be provided in the Mental Health unit in CUH. A consultation process in relation to this will commence in Q1 with staff, service users and carers with the intention to commence implementation in Q2.
A reorganisation of staff, inclusive of all nursing grades, will facilitate the redeployment of significant numbers of staff to Community Mental Health Services. As part of our programme to reduce admissions and improve service user satisfaction, we will further develop our community services by providing Community Mental Health Nurse cover in all areas on a 7 day week basis. This enhanced service will form part of all existing services in operation, such as Home Based Treatment Teams etc.
In addition to this, management propose to further invest in community services by regularising 3 Advanced Nurse Practitioner posts to ensure formal/seamless links with Community Mental Health Teams and Primary Care.
Service Improvements / Enhancements Commence planning for intensive care regional unit (regional forensic unit) as part of a bespoke model with Central Mental Hospital. Extend Child and Adolescent Inpatient Unit from eight to twenty beds. Complete the strategic plan for the implementation of Vision for Change in Cork. Implement new management structures for mental health services in Cork which include one Executive Clinical Director for Mental Health Services in Cork and one Executive Management Team. Continue to develop service user involvement in the planning and delivery of mental health services. Suicide prevention services - Promote positive mental health and prioritise suicide prevention; in particular, implement outstanding actions in Reach Out- the National Strategy for Action on Suicide Prevention Strengthen General Adult Community Mental Health Team (CMHT) capacity by ensuring, at a minimum, that at least one of each mental health professional discipline is on each general adult community mental health team.
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Implement agreed clinical care programmes in mental health. Develop effective partnerships with voluntary and statutory agencies to deliver integrated care for service users.
Kerry . In Kerry there will be a further reduction of 10 beds with the closure of St. Martin’s (female) Ward and the subsequent transfer of the patients to more appropriate settings in community residences as well as the adjacent O’Connor home residential unit. This will progress the closure of St. Finan’s Hospital and will see that the only remaining patients in the main building of the hospital will be accommodated in a 10 bed male, high dependency unit.
. In 2012 a four bed, high observation area will be developed at the acute unit of Kerry General Hospital. This will support the current policy of the non admittance or transfer of patients to St. Finan’s Hospital. A reduction of the overall acute bed numbers from the current 44 to 38 will also be undertaken and this will also allow for the redeployment of nursing staff to community mental health teams in the area.
. A process will also commence that will see the ultimate closure of the supported hostel in Caherciveen in South Kerry with the patients moving to more appropriate accommodation in the community over a period of time. This will also allow for a redeployment of staff to the community mental health team in South Kerry.
Improving our Infrastructure Capital projects that are to be completed and / or to become operational in 2012:
Location Capital Project Target Date Tipperary South Provision of a 40 Bed Residential Unit, on the existing site, to accommodate current residents of St Luke's Q1 2012 Tipperary South High Support Hostel, Clonmel. Q2 2012 St John’s Enniscorthy Rehab House – Tus Nua Q4 2011 Mill View 13 place High Support House in grounds of St John's Enniscorthy to rehouse St Sennan's St John’s Enniscorthy Q4 2012 residents Day Hospital & Accommodation for Sector Team and Psychiatry for Later Life Team. Funded from sale of Clonmel, Tipperary Q1 2012 lands Waterford Regional Hosp Upgrade Acute MH Unit. Q2 2012 Wexford Two Intellectual Disability Houses - Haven View 1 & 2 Q4 2012 Wexford 50 Bed Community Nursing Unit Q4 2012 Kerry General Hospital High Observation Unit Q4 2012
Key Result Areas The following Key Performance Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Positive Mental Health and Implementation of Reach Out – National Strategy for Action on Suicide Prevention and the Q4 Suicide Prevention Management of Self-Harm Presentations to ED Clinical Programme Mental Health Promotion Continue the roll out of ASIST and Safetalk programmes by training an additional 4,000 and Ongoing 2,000 people, respectively, per annum Maintain the public mental health awareness campaigns to encourage positive mental health and reduce stigma associated with suicide and mental health General Adult Community Expand and rationalise the membership of general adult CMHTs to ensure improved Ongoing Mental Health Teams multidisciplinary representation. (The allocation of additional resources to professionally complete General Adult CMHTs is contingent on those teams implementing the mental health clinical programmes when agreed) DNE - merge CMHTs to achieve economies of scale coterminous with Health and Social Ongoing Care Networks Child and Adolescent Complete the multidisciplinary profile of the existing Child and Adolescent CMHTs to include Ongoing Community Mental Health at least one of each profession (medical, nursing, clinical psychology, social work, Teams occupational therapist, speech and language therapist, child care worker) Child and Adolescent Acute Implement measures to increase acute inpatient capacity: Inpatient Capacity . South: Child and adolescent acute inpatient unit open to full capacity in Bessboro, Q1 Cork HSE South 72
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Target Completion Key Result Area Deliverable Output 2012 Quarter . West: Child and adolescent acute inpatient unit open to full capacity in Merlin Park, Q4 Galway . DNE: Additional 6 beds in Phase 2, St. Vincent’s Fairview capital project completed Q2 . DML: Development of 8 bed interim Child and Adolescent Acute Inpatient Unit for St. Q1 Loman’s, Palmerstown . DML: Commissioning of Day Hospital in Cherry Orchard Q1 Enhance Young People’s In partnership with Headstrong, progress the six new Jigsaw sites in development through Ongoing Mental Health the allocation of €1m Innovation Funding Rationalise Acute Inpatient Reduction of a minimum of 153 adult acute inpatient beds nationally Provision in line with A South (301 acute beds currently) Ongoing Vision for Change . Reduce by 60 beds to 241 HSE South . Closure plans for St. Mchaels Unit , Clonmel will be progressed (29 beds) Q1 . Reorganisation of acute unit in KGH to provide high obs. Unit (6 beds) Q4 . Closure oin the order of 25 acute inpatient beds in Cork will b e progressed in with Q1-Q4 VFC and re-organisation of acute services in Cork West (331 acute beds currently) . Donegal / Sligo / Leitrim – reduce by 15 acute beds . Galway / Mayo / Roscommon – reduce by 37 acute beds . Limerick / Clare / North Tipperary – reduce by 30 acute beds DNE (205 acute beds currently) . Closure plans for St Brigid’s Ardee will be progressed in line with the new unit in Drogheda . Closure of acute inpatient beds in St Vincent’s Hospital, Fairview will be progressed in line with the refurbishment of the acute beds at Mater Hospital DML (270 acute beds currently) . Reduction by 10 beds to 260 Discontinue direct medium and low support housing provision managed by the mental health services (This does not impact on the provision of clinical support) HSE South . Review current stock of medium and low support community residences Q1 . Conduct comprehensive needs assessment for existing residents Q2 . Liaise with local authorities / seek competent partner agencies to operate medium Q3 - Q4 and low support community residences Closure of old psychiatric Continue to work with all stakeholders to plan for the closure to admissions of old psychiatric Ongoing hospitals to acute inpatient hospitals admissions West – Progress closure of St Joseph’s Hospital in Limerick DNE – Closure of St Brigid’s Ardee will be progressed in line with the new unit in Drogheda South – St Luke’s Clonmel will close as an approved centre in 2012 and in St Finans, direct admissions will cease by Q1 DML – Complete the closure of the old psychiatric hospital at St Loman’s Mullingar Inappropriate Placements Establish a Working Group with Disability Services to address people with intellectual Q1 disability inappropriately placed in psychiatric settings Mental Health in Primary Mental Health in Primary Care Care and Access to Continue participation by PCTs in the team based approaches to mental health in the Q1 Psychotherapy Services Primary Care Accredited Programme, as funding permits Provide access to psychotherapy and counselling for patients eligible under the general Ongoing medical services National Forensic Mental Replacement of Central Mental Hospital (CMH) Health Services Progress the project plan to relocate CMH to St. Ita’s Portrane and progress associated Ongoing national forensic infrastructure to include Forensic CAMHS Unit, Forensic Mental Health Intellectual Disability (MHID) Unit and provision of 4 ICRUs DML Complete high support hostel and outreach service for people granted conditional discharge Q1 under Criminal Law Insanity Acts Clinical Care Programmes Prepare a detailed plan for the implementation of the agreed mental health clinical Q2-Q4 in Mental Health programme Voluntary and Statutory Continue to work with statutory and voluntary agencies to improve social inclusion for Ongoing Agencies service users – housing authorities, gardai, educational and training agencies Continue to work with voluntary partners in mental health to ensure co-ordinated delivery of
HSE South 73
MENTAL HEALTH SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter services across agencies in line with objectives of A Vision for Change Service User and Carer Ensure service user representation on Area Mental Health Management Teams Ongoing Partnership Embed Recovery Ethos Implement the guidelines for the delivery of recovery-focused mental health services Q2-Q4 Mental Health Services Complete the multidisciplinary Mental Health Services Management Teams in all operational Q2 Management areas through reconfiguration of existing management roles Establish the business requirements for a national Mental Health Information System Q2 Fostering Innovation Allocation of €2m to Genio to accelerate innovative practice and service modernisation in Ongoing mental health in line with A Vision for Change
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South Adult Inpatient Services No. of admissions to adult acute inpatient units 4,712 4,338 4,338 Median length of stay 11.0 12 12 Rate of admissions to adult acute inpatient units per 100,000 population 108.9 101.3 93.5 in mental health catchment area First admission rates to adult acute units (that is, first ever admission), per 33.5 31.9 29.4 100,000 population in mental health catchment area Acute re-admissions as % of admissions 69% 68% 68% Inpatient re-admission rates to adult acute units per 100,000 population in 75.4 69.3 64.0 mental health catchment area No. of adult acute inpatient beds per 100,000 population in the mental 26.4 26.4 20.7 health catchment area No. of adult involuntary admissions 384 415 415 Rate of adult involuntary admissions per 100,000 population in mental 8.85 9.7 8.9 health catchment area Child and Adolescent No. of child and adolescent Community Mental Health Teams 13 13 13 No. of child and adolescent Day Hospital Teams --- - - No. of Paediatric Liaison Teams --- - - No. of child / adolescent admissions to HSE child and adolescent mental --- 29 29 health inpatient units No. of children / adolescents admitted to adult HSE mental health <100 130 80 inpatient units* (National) (National) (National) i). < 16 years 4 0 33 16 ii). < 17 years 93 64 iii). < 18 years No. and % of involuntary admissions of children and adolescents 16 16 16 5% 5% 5% (National) (National) (National) No. of child / adolescent referrals (including re-referred) received by 2,795 2,957 2,957 mental health services No. of child / adolescent referrals (including re-referred) accepted by 1,734 1,674 1,674 mental health services Total no. of new (including re-referred) child / adolescent referrals offered 1,729 1,857 1,857 first appointment and seen No. and % of new / re-referred cases offered first appointment and seen i). < 3 months 1,134 1,307 70% (National) 61% ii). > 12 months 283 210 10% 0% (National)
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MENTAL HEALTH SERVICES
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South No. and % of cases closed / discharged by CAMHS service New PI 1,734 1.734 80% of accepted 97% 80% referrals Total no. on waiting list for first appointment at end of each quarter 666 447 465
No. and % on waiting list for first appointment at end of each quarter by wait time 208 137 139 i). < 3 months 31% 30% ii). 3-6 months 136 102 111 23% 24% iii). 6-9 months 172 104 115 23% 25% iv). 9-12 months --- New PI 99 21% v). > 12 months 150 104 0 23% No. of suicides in arrears per CSO Year of Occurrence New PI National: 506 --- (2008 validated) No. of repeat deliberate self harm presentations in ED National: 1,342 National: 1,348 National: 1,348 1% reduction on 2010 *The Mental Health Commission Regulations recognise that there will be occasions where it is clinically necessary to admit a child to an adult unit
HSE South 75
Disability Services
Introduction Resources A major change programme for disability services in Ireland has commenced FINANCE – HSE SOUTH in recent years. Service provision has been moving towards a community- based and inclusive model rather than being institutional and segregated. 2011 2012 This process is now gathering momentum towards achieving the vision of a Area Budget Budget €m €m society where people with disabilities are supported to participate fully in economic and social life, and have access to a range of quality supports and Cork 186.433 179.422 services to enhance their quality of life and well-being. Kerry 1.927 1.854
The emerging DoH policy direction (Value for Money and Policy Review), Carlow /Kilkenny/Sth Tipp 56.180 54.090 coupled with recommendations from HSE national working groups on key Waterford/Wexford 71.676 68.971 service areas such as congregated settings and day services, has Total 316.216 304.337 emphasised the need for a new model of service provision that, if agreed by Government, will further the independence of people with disabilities in a WTE Ceiling – HSE SOUTH manner which is efficient and cost-effective. This will include a robust Dec 2011 Projected Area implementation plan which will be developed through the National Dec 2012 Consultative Forum and will include a monitoring and evaluation framework. Cork 2,161 2,093 The findings and recommendations of the Value for Money and Policy Kerry 12 12 Review will provide the framework within which the constituent parts of the overall change programme will be developed and driven. This radical change Carlow /Kilkenny/Sth Tipp 304 295 is not the sole responsibility of the HSE but, rather, a collaborative Waterford/Wexford 772 747 responsibility shared between the person, their families and carers, a Total 3,249 3,147 multiplicity of agencies, Government, and society as a whole.
The allocation for disability services nationally will reduce in 2012 by 3.7% as a consequence of the impact of the efficiency, procurement and targeted pay reduction savings. In addition, disability services will be required to cater for demographic pressures, such as new services for school leavers and emergency residential placements, from within their existing budgets. While the allocation will reduce by 3.7% nationally, there is scope for achieving efficiencies of 2% or more through measures such as consolidation and rationalisation of back office costs. Some providers have made significant progress in this regard in recent years but considerable scope for savings remains in the case of others. All providers will be expected to achieve some efficiency savings but the level of savings will vary depending on the profile of the service provider, efficiency savings achieved to date and the scope for further savings. HSE managers will have the scope, within the national figure of 3.7%, to vary the level of reduction which will apply to individual service providers. The HSE will work closely with the Department in finalising the allocations.
Some reductions in services will be unavoidable even with such efficiencies. These will arise in day services, residential and respite services. The aim will be to tailor such reductions in a way which minimises the impact on service users and their families as much as possible. There is evidence that an accelerated move towards a new model of individualised, person centred service provision in the community can help to achieve efficiencies, particularly in relation to services for those with mild or moderate intellectual disability.
Provision has been made for investment of €1m nationally for autism services. This will be used to address waiting times for specialist therapy services for children who have been diagnosed with autism and on developing Early Intervention Teams.
The National Service Plan has identified the following priorities for 2012: . Maximise the provision of services within available resources. . Develop and continue a total system reorganisation of service provision though the implementation of: - The programme for Progressing Disability Services for Children and Young People - The Review of Autism Services - Reconfiguring adult day services as outlined in New Directions: Report of the National Working Group for the Review of HSE Funded Adult Day Services - Reconfiguring residential services as recommended in Time to Move on From Congregated Settings, and - The National Neuro-Rehabilitation Strategy. . Develop systems and processes to mainstream all services in the community such as speech and language therapy, occupational therapy and physiotherapy in collaboration with primary care and network teams. . Support organisations in the delivery of high quality and safe services, in preparation for the commencement of a system of registration and inspection of residential services for adults and children with disabilities. . Implement measures to ensure that children assessed under the Disability Act, 2005 receive those assessments in accordance with the standards laid down, and that processes are improved and services reorganised in order to make progress towards compliance with the timeframes set out in legislation.
HSE South 76 DISABILITY SERVICES
. Review the current information systems and information needs for disability services and make recommendations for future planning. . Develop an action plan including short, medium and long-term goals, for the implementation of the recommendations of the VFM and Policy Review.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Service Quantum In 2012 we will provide: . 361,203 * personal assistant / home support hours. . 2,152 residential places . Provide respite services for 1,559 service users . Day place provision for 5,349 service users . Therapy services and therapeutic support . Community support services for clients with specific conditions by specialised services i.e. Muscular Dystrophy Ireland . Home support (children) . Outreach support services for adults with specific disabilities i.e. Asperger’s Syndrome * negotiations to take place in relation to rates
Cost Management & Employment Control Measures The budget reduction amounts to €11.576m which represents a 3.7% reduction. The range and quantum of services to be provided in 2012 (as outlined above) takes account of the reduction in 2012 budget. Notwithstanding a reduction in funding and the assignment of efficiency targets along with a reduction in staff numbers, agencies will be required to re-direct resources to respond to emergency cases in 2012. The cost management measures necessitated by the reduced funding available for disability services in 2012 are summarised below. Every effort is made to ensure that the impact on services is minimised. . Reduction in funding to voluntary agencies will amount to 3.7% of 2011 revenue funding, a minimum of 2% will be sought from cost efficiencies, with the remaining reduction of up to 1.7% being found from service reductions . The 2% cost containment reduction will be achieved by maximising the opportunities for agencies cost reduction in areas of non-pay and non-core activity expenditure i.e. management costs, transport costs, shared services costs. In addition, there will be a review of Pre-School supports, high cost services and expenditure on provision by private providers. Some current management and supervisory posts will be redeployed to frontline services. We will also be reviewing staffing levels, reducing overtime and agency costs and increasing skill mix and other measures to limit impact on frontline services. . All smaller agencies that carry fixed overheads are to examine options for amalgamation/sharing services. . While every effort is made to minimise the impact of the budget reductions on services without effecting core service delivery, many agencies have indicated that they will note be in a position to absorb the full 3.7% impact of this budget reduction, therefore there may be some service impact in the areas set out below: Potential reduction of up to 6,140 PA Hours (1.7%) Potential reduction of up to 37 residential care places (1.7%) by reducing places from 7 to 5 nights where possible Reduction of 1.7% on core funded respite services Reduction of 1.7% in WTE day places (achieved by reducing number of days / length of stay) Reduction of transport services . HSE Services: Damien House, South Tipperary – Revise rosters to meet service demands and change model of delivery of day services to ensure continuity of the residential services Cease service in Teach Saoirse Community House to consolidate residential services for clients in Wexford Reorganisation of rosters and skill mix in St Raphael’s/Grove House (Cork) in line with declining bed numbers/changing needs . Reduction in Aids and Appliances expenditure . A review of services provided by Section 38 / 39 Agencies will be carried out in a number of areas.
HSE South 77
DISABILITY SERVICES
Service Improvements . Relocate a further 6 clients on the St Raphael's Campus, Youghal to the new Unit E which is a purpose built challenging behaviour unit on the grounds. Transfer of these clients to more appropriate accommodation will allow for further re-organisation of the service and closure of a dormitory in the main building . VFM and Policy review - Develop regional and area level implementation plans in line with the outcomes of the National VFM and policy review . Maintain provision of core services at identified levels while we reconfigure and re-organise services generally . Progress development of alternative respite care models for greater cost efficiency . Commence the redevelopment programme of the Grove House 28 bed Residential Service . Complete the rollout of the Consultative Fora structure with Area level groups to be established across the HSE South . Continue implementation of the "Time To Move On From Congregated Settings" policy in line with National plan: Implement agreed target date when set, for cessation of new admissions to congregated settings Complete Genio funded projects at selected demonstration sites including St Raphael’s Centre . Progressing Disability Services for Children and Young people: Complete mapping and establishment of implementation groups in HSE South Develop regional and area level implementation plans in consultation with key stakeholders Complete reorganisation in identified lead sites/ areas (West Cork/Kerry)
Key Result Areas The following Key Performance Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Service Provision and Total Develop systems and processes to ensure that, where appropriate, people with disabilities Ongoing System Reconfiguration access services in the mainstream of primary care services In conjunction with the National Disability Authority (NDA), develop a resource allocation Q3 model reflective of the service arrangements and the recommendations of the VFM and Policy Review Test a system of resource allocation through demonstration projects Q4 Develop an action plan to implement the recommendations of the VFM and Policy Review Q2 Develop new models of service provision, such as Host Family Support, to improve the Ongoing choice available to people with disabilities Conduct a pilot of alternative models of respite care provision in Mid-West service area Q3 Progressing Disability Services for Children and Young People Continue development of regional and area level implementation plans Q2-Q4 Establish clear pathways and links to school services Q3 In those areas where plans are completed, commence the reconfiguration of available Q3 resources with key stakeholders Review of Autism Services Link with children’s disability services programme and engage with service providers and Q1 education sector Develop regional and area level implementation plans and commence implementation Q3-Q4 based on the review’s recommendations, taking cognisance of relevant aspects of other policies such as the Congregated Settings and New Directions reports Disability Act 2005 Ongoing Continue to refine the processes under the Act and integrate them into the services for children and young people as they are reconfigured, in order to develop more efficient provision of children’s therapy services Implement the recommendations of the NDA’s study of the determinants of an efficient and effective assessment of need Child Protection and Welfare Agency Maintain close co-operation with services for children and families during the development Q1-Q2 of the Child Welfare and Protection Agency to ensure that services for children with disabilities are delivered appropriately and develop clear protocols in this regard
HSE South 78
DISABILITY SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter Adult Day Services Continue to liaise with the DoH and the relevant Government Departments, through the Q1-Q2 mechanism of the Cross Sectoral Working Group on an Employment Strategy for People with Disabilities, on arrangements for the future provision of sheltered and supported employment by the appropriate department / agency Develop a high-level, national implementation plan taking a phased approach and working Q1 with those providers already progressing the agenda for change, or in readiness for same (In conjunction with key government departments) Develop regional and area level implementation plans, based on the national Q3 implementation plan Congregated Settings – Reconfiguration of Residential Services Monitor current projects to ensure they deliver on expectations and disseminate the Ongoing learning from the projects In conjunction with Genio, identify and implement a number of demonstration sites to test Q2-Q4 feasibility and identify best practice Agree a date for the cessation of admissions to congregated settings Q3 In conjunction with the Department of Environment, Community and Local Government Q1 develop a high-level, national framework to ensure co-ordination between the implementation of the recommendations of the report on congregated settings and the National Housing Strategy for People with a Disability Develop a national implementation plan taking a phased approach and working with those Q2 providers already progressing the agenda for change, or in readiness for same Develop regional and area level implementation plans in consultation with key stakeholders Q3 and based on the national implementation plan Reconfiguration / rationalisation of residential places (Genio projects): Ongoing . DML - 50 people to be moved from congregated settings . South - 10 people to be moved from congregated settings Review of Performance Measures / Indicator Set In conjunction with the DoH, carry out a comprehensive review of the full performance Q4 indicator set to bring it into line with the new policy direction and make it fit for purpose Relocation of Persons with ID inappropriately placed in psychiatric settings Continue to transfer people to more appropriate settings, progressed through an agreed Q4 implementation plan Establish a working group with Mental Health Services to progress Q1 Neuro-Rehabilitation Strategy Work with the Rehabilitation Medicine Programme to support the development of an Ongoing implementation plan based on the recommendations of the National Neuro-Rehabilitation Strategy Establish Regional Rehabilitation Networks Q2 Commence development of regional inpatient rehabilitation facilities Q3-Q4 Registration and Inspection Update and maintain database for adults and for children in residential and respite services Q1 of Residential Services for Share the learning from the self audit of a percentage of adult residential services with all Q1 Adults and Children with providers via the umbrella organisations to develop the next phase of preparation Disabilities Develop an action plan and self-audit tool for children’s residential services to support Q2 quality improvement, assurance and compliance with the draft standards Child Protection Audit Using information gathered from phase 1 of the audit, identify findings in relation to policy, Q2 process and training in order to inform national policy Information Systems Carry out a review of the existing information systems in disability services in both the Q2 statutory and non-statutory sectors Carry out a review of information needs in both sectors Q2 Make recommendations for future planning in this regard Q3 Thalidomide in Ireland Continue to work with Beaumont Hospital to support the development of an agreed Q1 multidisciplinary team (MDT) assessment process
HSE South 79
DISABILITY SERVICES
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Projected Outturn Expected Activity /
Target 2011 2011 Target 2012 South South South Day Services No. of work / work-like activity WTE places provided for persons with 460 583 1,578 (National - intellectual disability (ID) and / or autism Regional breakdown to be determined) No. of persons with ID and / or autism benefiting from work / work-like 951 1,174 3,084 activity services (National - Regional breakdown to be determined) No. of work / work-like activity WTE places provided for persons with 12 21 71 physical and / or sensory disability (National - Regional breakdown to be determined) No. of persons with physical and / or sensory disability benefiting from 23 34 138 work / work-like activity services (National - Regional breakdown to be determined) No. of Rehabilitative Training places provided (all disabilities) 653 653 653 No. of persons (all disabilities) benefiting from Rehabilitative Training (RT) 762 780 780 No. of persons with ID and / or autism benefiting from Other Day Services 14,077 (National) 2,791 12,430 (excl. RT and work / work-like activities) (National - Regional breakdown to be determined) No. of persons with physical and / or sensory disability benefiting from 3,924 (National) 570 2,581 Other Day Services (excl. RT and work / work-like activities) (National - Regional breakdown to be determined) Residential Services No. of persons with ID and / or autism benefiting from residential services 2,198 2,015 8,416 (National - Regional breakdown to be determined)
No. of persons with physical and / or sensory disability benefiting from 226 137 708 residential services (National - Regional breakdown to be determined) Respite Services No. of bed nights in residential centre based respite services used by 26,706 40,200 139,565 persons with ID and / or autism (National - Regional breakdown to be determined) No. of persons with ID and / or autism benefiting from residential centre 1,121 1,327 5,115 based respite services (National - Regional breakdown to be determined) No. of bed nights in residential centre based respite services used by 1,676 1,257 13,782 persons with physical and / or sensory disability (National - Regional breakdown to be determined) No. of persons with physical and / or sensory disability benefiting from 819 232 1,220 residential centre based respite services (National - Regional breakdown to be determined) Personal Assistant (PA) / Home Support Hours No. of PA / home support hours used by persons with physical and / or Original Target NSP11 1.64m sensory disability required reclassification due 361,203 (National - Regional to definitional issues breakdown to be determined) No. of persons with physical and / or sensory disability benefiting from PA Original Target NSP11 5,931 11,571 / home support hours required reclassification due (National - Regional
HSE South 80
DISABILITY SERVICES
Expected Activity / Projected Outturn Expected Activity /
Target 2011 2011 Target 2012 South South South to definitional issues breakdown to be determined) Disability Act Compliance No. of requests for assessments received 1,091 1,180 1,298 No. of assessments commenced as provided for in the regulations 848 1,039 1,188 No. of assessments commenced within the timelines as provided for in 848 612 1,188 the regulations No. of assessments completed as provided for in the regulations 733 1,052 1,188 No. of assessments completed within the timelines as provided for in the 733 161 1,188 regulations No. of service statements completed 733 765 1,010 No. of service statements completed within the timelines as provided for 733 479 1,010 in the regulations Services for Children and Young People % progress towards completion of local implementation plans for New PI New PI 100% (National) progressing disability services for children and young people Note: Due to regional variations in service developments and budget allocations, data collected under the current performance indicators has become increasingly unreliable. For this reason, and in order to bring the PI set into line with the new policy direction, there will be a comprehensive review in 2012.
HSE South 81
Child Protection and Welfare Services
Introduction Resources HSE South Children and Families Services aim to promote and protect the FINANCE – HSE SOUTH health and well being of children and families, particularly those who are at risk of abuse and neglect. In this regard, the HSE South is responsible under 2011 2012 Budget Budget the Child Care Act, 1991 and other legislation to promote the welfare of Area €m €m children who are not receiving adequate care and protection. Child protection and welfare services are also provided in accordance with the Children Act, Cork 48.840 50.272 2001 and the UN Convention on the Rights of the Child, ratified in 1992. Kerry 8.179 8.399 Carlow /Kilkenny/Sth Tipp 30.192 30.949 A wide range of services are provided, including early years services, family Waterford/Wexford 26.208 26.938 support services, child protection services, alternative care, services for Regional - - homeless youth, search and reunion (post adoption) services, psychological Total 113.419 116.558 services, staff training and development, registration and inspection of children’s residential centres in the private and voluntary sector and WTE Ceiling – HSE SOUTH monitoring of children’s residential centres. These services are provided Dec 2011 Projected directly by us, or indirectly on our behalf under Section 39 of the Health Act, Area Dec 2012 2004. We are committed to the principle of supporting families as the basis for Cork 449 440 ensuring child health and welfare. Kerry 64 62 Carlow /Kilkenny/Sth Tipp 269 264 The focus of Children and Families Services in 2011 was the improvement in Waterford/Wexford 251 249 the quality and consistency of services. During 2011 Standardised Total 1,033 1,015 Processes were introduced in all Social Work teams to address Referral, Intake and Initial Assessment of all reports of welfare or abuse concerns about children. The revised Children First: National Guidance for the Protection and Welfare of Children was introduced in July and in September the HSE introduced a Child Welfare and Protection Practice Handbook to support frontline practitioners.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Service Quantum and Service Delivery Under the Programme for Government, fundamental changes as to how child and family services are delivered in Ireland are proposed in order to develop a service that is fit for purpose. These changes will be achieved firstly through the delivery of a major reform programme for family support, child protection and alternative care, accompanied by the associated changes in management structures. The financial challenge in the short to medium term will be examined and the method of allocating resources reviewed. Systems will be strengthened to ensure priorities are determined according to need.
Secondly the programme is aligned to the emerging development of the new children’s agency under the aegis of the newly established Department of Children and Youth Affairs. This is particularly relevant as the new agency will assume responsibility for the services presently delivered by the HSE. The change will be informed by the need for: . A commitment to putting the well being and interests of children first . Transparent accountability and clearly articulated levels of responsibility, and . Increased community engagement and a commitment to deliver inclusive, accessible services. The primary focus of this plan for children and families in 2012 is to support the implementation of the comprehensive change programme which has consolidated all the reform initiatives arising from recent reviews into a co-ordinated change programme. In 2012 we will: . Provide Foster Care services for 1,685 children . Provide direct HSE Residential Care services for 100 children while reducing costs related to private residential care provision and reducing reliance on additional external provision. . Support an additional 50 Other Care Placements HSE South 82 CHILD PROTECTION AND WELFARE SERVICES
. Complete 50 Adoption Assessments; Approx 300 Post Placement Reports . Undertake a total of 700 Early Year Services Inspections . Process approximately 9,500 referrals to Social Work Services . Streamline provision of Aftercare Services through standardisation of approach and payments across the region. . Complete the evaluation of Pilot Out of Hours Social Work Service (Cork) . Place an emphasis on the reduction in costs associated with agency staffing through management of absenteeism and re-organisation of staff rosters. . Progress and implement the revised Governance and Accountability arrangement for Children & Family Services . Implement child protection procedures in line with the revised national guidelines - Children First 2011 – National Guidance for the Protection and Welfare of Children and implement Phase 2 of the Standardised Business Processes.
The National Service Plan has identified the following priorities for 2012: . Promote the major culture change required in planning and delivering services to children and their families. . Implement consistent child protection procedures in line with the revised national guidelines - Children First, 2011 – National Guidance for the Protection and Welfare of Children. . Continue the reforms necessary to provide a comprehensive range of high quality services for children in care. . Improve effective multidisciplinary shared practice and efficient community engagement.
Cost Management & Employment Control Measures Child Protection and Welfare Services have had an increase of €3.139m (2.7%) in budget in HSE South. However, this increase is against a backdrop of budgetary over runs in 2011 and cost management measures are required to reduce the cost base as set out below: . Reduce costs related to private residential care provision by maximising capacity in HSE services and reduce reliance on additional external provision. . Establish standardisation of approach and payments across the region for After Care Services. . Reduction in costs associated with agency staffing through management of absenteeism and re- organisation of staff rosters. An independent review of staff rostering in HSE residential units is currently taking place in order to facilitate a more flexible approach in the services provided. It is envisaged that following the review more efficient rosters will be established providing greater capacity and cost savings. . Reduction in funding to voluntary agencies in line with national direction . Back office services efficiencies / reduction in travel expenses, procurement etc. . Reduction in level of enhanced Foster Care payments and limits on discretionary payments in excess of standard weekly foster care payment. No reduction in service anticipated. . Reduction in purchase of external professional clinical services.
Service Improvement . Ongoing review of private residential placements . Evaluation of Pilot Out of Hours Service Social Work Service (Cork). . HSE South will progress and implement the revised Governance and Accountability arrangement for Children & Family Services. . HSE South in line with national direction will regionally implement consistent child protection procedures in line with the revised national guidelines - Children First 2011 – National Guidance for the Protection and Welfare of Children. . Introduction of Phase 2 of Standardised Business Process in all local areas.
Key Result Areas The following Key Result Areas (KRAs) have been included in the National Service Plan for delivery in 2012: Target Completion Key Result Area Deliverable Output Quarter Delivery of statutory services Maintain progress to ensure that all children in need of care and protection are assessed in a timely fashion, have an allocated social worker and defined care plans, which are reviewed as per the regulations: . Participate in the process to review the standards for children in care Q1 . Review the use of supervision orders and establish a national protocol Q1 . Increase use of supervision and other protective strategies to maintain children Q3 at home safely HSE South 83
CHILD PROTECTION AND WELFARE SERVICES
Target Completion Key Result Area Deliverable Output Quarter . Monitor the application of the national practice guidance on compliance with Q3 Section 3 of the Child Care Act Cultural Change Implement procedures whereby all children are consulted about decisions that affect them, and children’s collective views influence policy development: . Develop a set of national standards and training on consultation with children and young people Q4 . Disseminate the Quick Guide for staff on working with children and young Q1 people . Determine an appropriate participation framework for the new Children and Q4 Family Agency Develop and implement a Quality Assurance and Audit Framework across child protection, welfare, and alternative care services: . Develop a Quality Assurance and audit framework Q3 . Introduce an audit tool to assess workload management in each Health Area Q3 . Prepare for the implementation of the HIQA child protection standards Q2 . Continue the audit of catholic church congregations and orders Q1 . Establish a national system to monitor local serious incidents at national level Q1 . Complete phase 1 of the set of Practice / Policy Manuals for Child Protection, Q4 Foster Care, Residential Care, Aftercare, Children First and Pre-Schools Consolidate arrangements to learn more from practice including serious case reviews: . Review formal processes for serious case and child death reviews and the Q1 analysis and learning from such reviews Revise and implement consistent Devise , in conjunction with interdepartmental group a project plan to support child protection procedures in the consistent implementation of the Children First National Guidance across all line with revised national relevant government sectors guidelines - Children First . Review and implement joint Agency / Garda protocols Q4 . Standardise and deliver HSE and An Garda Siochana Joint Children First Q3 training provided to child protection social work staff and relevant gardai . Commence joint HSE / Gardai scenario training (HYDRA) to key senior Q4 management at multiagency level . Complete Children First briefings for HSE funded agencies Q3 . Enforce adherence to Children First guidance through Service level Q3 agreements . Implement a plan to support government departments and non funded services Q1 in relation a consistent standardised implementation of Children First . Joint HSE / Garda Specialist interview training Q4 Ensure that child protection services can be readily accessed by local communities . Develop a new National Service Delivery Model for children and family services Q4 in line with Children First, the Standardised Business Processes, and learning from pilot development sites Policy framework to revise and develop a consistent Child Protection system . Standardise the implementation and structure of case conferences Q1 . Standardise thresholds for care and protection Q1 . Develop and implement a risk assessment and measurement tool Q1 . Develop a system for monitoring workloads Q2 . Develop a system of how cases are prioritised and allocated Q2 . Establish a Child Protection Register Q2 . Develop a framework for further assessment Q2 Re-enforce consistent, objective, evidence-based initial and core assessments which clearly assess the level of risk: . Review the implementation of Phase 1 of the standard business process which Q2 include implementation of a standardised initial assessment . Implementation of Phase 2 of the standard business process Q3 . * Complete the implementation of the recommendations of 2007 Report on Q4 Treatment Services for Persons who have Exhibited Sexually Harmful Behaviour . * Review and evaluate the out of hours pilot sites Q1
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CHILD PROTECTION AND WELFARE SERVICES
Target Completion Key Result Area Deliverable Output Quarter . * Analysis and identification of best practice of addiction services for children Q3 nationwide Complete a series of reforms Provide time in care which is commensurate with the child’s needs through the necessary to provide a development and implementation of an integrated children services programme: comprehensive range of high . Design an implementation plan based on the recommendations from the review quality services for children in of capacity within the alternative care services Q1 care . Develop a Corporate Parenting Strategy for children and family services Q4 . Establish, in partnership with advocacy agencies, four regional forums for Q3 children and young people in care Ensure that there is up to date, timely, and accurate data on the number and circumstances of all children in the care system: . Continue project on Management Information Frame work including the Q4 development of appropriate performance indicators . Select and procure a national case management information system (the Q3 national childcare information system) . Prepare the service for the introduction of the national childcare information Q3 system * Complete the reform and modernisation of the special care service and associated therapeutic interventions: . Establish a national therapeutic team for children in care and detention Q2 . Establish a national forensic mental health team for children at risk Q2 Ensure efficient and effective liaison with the new adoption authority by establishing a Q2 strategic planning forum with the Adoption Authority Introduce and implement procurement process for high tariff alternative care Q3 placements * Monitor implementation of the HSE aftercare policy Q3 Ensure that homeless children are given full access to children and family services under the Child Care Act 1991: . Revise policy on Section v of the Child Care Act 1991 implemented Q1 . Implement a policy on the use of accommodation options and on the use of Q3 and assessment criteria on supported lodgings providers . * Project plan for archiving records of all children in care Q3 . * Exit interview conducted with children leaving or changing care placements Q3 . * Data collection regarding children form ethnic minority backgrounds Q3 commenced Promote effective Take forward consistent family support arrangements as per the Family Support multidisciplinary shared practice Action plan: and efficient community . Develop a national and local commissioning strategy for community / voluntary Q4 engagement sector . Develop a community-based prevention and early intervention strategy Q2 . * Commission additional counselling services for survivors of abuse Q3 . Commence the establishment of partnership with advocacy agencies, four Q4 regional care forums for children and young people Continue to support the children’s services committees and contribute to the Q4 departmental review of future initiatives in this area Implement the National Standards for Pre-School Services in a cross- departmental and cross-agency manner: . Develop an Early Years framework inspection model for inspection of Early Q3 Childhood Care and Education (ECCE) settings in collaboration with DES Inspectorate (Field Study) . Develop and implement national agreed standard operating policies / Q4 procedures with related business processes for the Early Years Inspectorate . Continue phased implementation of the Pre-School Standards Q4 Work Force Development . Develop a Children and Family Services Workforce Development Strategy Q4 incorporating a national structure and work programme that reflects national priorities and addresses continuous professional development needs for relevant staff . Develop court practice and procedure skills training Q4
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CHILD PROTECTION AND WELFARE SERVICES
Target Completion Key Result Area Deliverable Output Quarter . Review of the National Child and Family Services Staff Supervision Policy Q4 (2009). Develop an implementation framework of standardised supervision . Implement rotation of social workers across childcare, child protection and Q3 welfare teams where appropriate . Deliver training for supervisors and supervisees Q4 . Deliver leadership development training to 17 Children and Family Managers Q4 and senior staff . Establish a probationary year of limited caseload, supervision and support for Q1 newly qualified social workers . Enhance practice placement supports for social work students Q1 Work to ensure that the priorities Prepare for the establishment of the New Children Agency as identified in the Programme . Progress transition arrangements with DCYA Q1 for Government are implemented . Develop a services delivery model Q1 relating to children and family services . Carry out a census of staff and resources Q1 . Develop an organisational design at regional and local level Q1 . Review the change programme in line with the framework of the new agency Q1 . Participate in the development of management structure and corporate Q1 governance
* Denotes implementation of actions arising from the Report of the Commission to Inquire into Child Abuse (Ryan Report), 2009 and the Commission to Inquire into Child Abuse.
Performance Activity and Performance Indicators The following Performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South After Care No. of young adults aged 18 to 21 in receipt of an aftercare New PI --- Baseline to be established in service on the last day of the reporting period 2012 No. of young adults aged 18 to 21 in receipt of an aftercare New PI --- Baseline to be established in service who are in full time education on the last day of the 2012 reporting period Child Protection – Child Abuse i). No. of referrals of child abuse and welfare concerns To be reported in 2011 --- Demand-led ii). % of referrals of child abuse where a preliminary enquiry took 78% (National) --- Baseline to be established in place within 24 hours 2012 iii). % of referrals which lead to an initial assessment New PI --- Demand-led iv). % of these initial assessments which took place within 21 100% (National) --- Baseline to be established in days of the referral 2012 v). % of initial assessments which led to the child being listed on New PI --- Demand-led the Child Protection Notification System (CPNS) Family Support Services No. of children referred during the reporting period New PI New PI Baseline to be established in 2012 No. of children in receipt of a family support service at the end of New PI New PI Baseline to be established in the reporting period 2012 Residential and Foster Care No. and % of children in care by care type 1,748 1,837 1,929 i). Special Care <0.2% (National) 0.2% 0.3% (National) ii). High Support <0.5% (National) 0.8% 0.5% (National) iii). Residential General Care (Note: Include special <6.3% (National) 4.7% <7% (National) arrangements) iv). Foster care (not including day fostering) 60% (National) 64.1% 59% (National)
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CHILD PROTECTION AND WELFARE SERVICES
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South v). Foster care with relatives 30% (National) 27.6% 30% (National) vi). Other care placements 3% (National) 2.6% 3% (National) No. and % of children in private residential care (Note: Include New PI New PI 0% (National) special arrangements) No. and % of children in foster care private New PI New PI 1% (National) No. of children in single care residential placements 0 (National) 5 0 (National) No. of children in residential care age 12 or under 0 (National) 7 0 (National) No. of children in care in third placement within 12 months (all 0 (National) 33 0 (National) care types) Children in Care in Education i). No. of children in care aged 6 to 16 inclusive New PI 1,119 1,175 ii). No. and % of children in care between 6 and 16 years, in full 1,095 time education 100% (National) 97.9% 100% (National) Allocated Social Workers No. and % of children in care who have an allocated social 1,826 worker at the end of the reporting period 100% (National) 99.4% 100% (National) i). No. and % of children in special care 3 100% (National) 100% 100% (National) ii). No. and % of children in high support 15 100% (National) 100% 100% (National) iii). No. and % of children in residential general care 87 100% (National) 100% 100% (National) iv). No. and % of children in foster care 1,170 100% (National) 99.3% 100% (National) v). No. and % of children in foster care with relatives 504 100% (National) 99.4% 100% (National) vi). No. and % of children in other care placements 47 100% (National) 100% 100% (National) Care Planning No. and % of children in care who currently have a written care 1,736 plan as defined by Child Care Regulations 1995, at the end of 100% (National) 94.5% 100% (National) the reporting period i). No. and % of children in special care 3 100% (National) 100% 100% (National) ii). No. and % of children in high support 15 100% (National) 100% 100% (National) iii). No. and % of children in residential general care 87 100% (National) 100% 100% (National) iv). No. and % of children in foster care 1,117 100% (National) 94.8% 100% (National) v). No. and % of children in foster care with relatives 473 100% (National) 93.3% 100% (National) vi). No. and % of children in other care placements 41 100% (National) 87.2% 100% (National) Foster Carer Total no. of foster carers New PI 1,272 1,336 No. and % of foster carers approved by the foster care panel New PI 1,147 1,202 90.2% 90% No. and % of relative foster carers where children have been 0% (National) New PI Baseline to be established in placed for longer than 12 weeks whilst the foster carers are 2012 awaiting approval by the foster care panel, Part III of Regulations No. and % of approved foster carers with an allocated worker 1,043 100% (National) 90.9% 100% (National) Children and Homelessness No. of children placed in youth homeless centres / units for more New PI New PI Baseline to be established in HSE South 87
CHILD PROTECTION AND WELFARE SERVICES
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South than four consecutive nights (or more than 10 separate nights 2012 over a year) No. and % of children in care placed in a specified youth New PI New PI Baseline to be established in homeless centre / unit 2012 Out of Hours No. of referrals made to the Emergency Out of Hours Place of New PI 121 127 Safety Service No. of children placed with the Emergency Out of Hours New PI 83 87 Placement Service No. of nights accommodation supplied by the Emergency Out of New PI 185 194 Hours Placement Service Early Years Services No. of notified early years services in operational areas 4,461 (National) 1,098 1,098 % of early years services which received an inspection 100% (National) 66.4% 100% No. and % of early years services that are fully compliant New PI --- Baseline to be established in 2012
No. of notified full day early years services New PI 347 347 % of full day services which received an annual inspection 100% (National) --- 100% No. of early years services in the operational area that have New PI --- Demand-led closed during the quarter No. of early years service complaints received New PI --- Demand-led
% of complaints investigated 100% (National) --- 100% (National) No. of prosecutions taken on foot of inspections in the quarter New PI --- Demand-led
HSE South 88
Palliative Care Services
Introduction Resources * Palliative Care provides the best possible quality of life for patients and their FINANCE – HSE SOUTH families when their disease is no longer responsive to treatment. Services are provided directly by the HSE and in partnership with voluntary agencies. 2011 2012 Area Budget Budget The principles of palliative care include: €m €m . A focus on quality of life Cork 5.625 5.139 . Maintaining good symptom control Kerry 0.940 0.861 . A holistic approach which takes into account the person’s life Carlow /Kilkenny/Sth Tipp 0.532 0.487 experience and current situation Waterford/Wexford 0.933 0.854 . Care that encompasses the patient and those who matter to them, Total 8.030 7.341 including support in bereavement . Open and sensitive communication with patients, carers and WTE Ceiling – HSE SOUTH professional colleagues. Dec 2011 Projected Area Palliative Care is applicable early in the course of illness, in conjunction with Dec 2012 other therapies that are intended to prolong life, such as chemotherapy and Cork radiation therapy, and includes those investigations needed to better Kerry 12 11 understand and manage distressing clinical complications. Carlow /Kilkenny/Sth Tipp In 2001 the report of the Department of Health and Children’s National Waterford/Wexford 2 2 Advisory Committee on Palliative Care outlined that the promotion of a Total 14 13 palliative care approach is appropriate for all patients and that a subset of * non‐acute hospital figures only patients with non-malignant disease with complex palliative care needs or multiple medical problems would benefit from specialist palliative care (SPC).
There is a growing awareness in Ireland that palliative care has a role in the management of all life-limiting diseases in all care settings. This is reflected in both policy documents and emerging practices.
More recently, in 2006, the HSE stated its commitment to develop a chronic disease management patient support programme. This is in response to the changing patterns associated with life-limiting diseases and to ensure delivery of appropriate health and care services to an ageing population. The development of such a programme is in line with the work of the World Health Organisation (WHO) whose recommendations include the provision of appropriate palliative care for all patients, regardless of diagnosis.
In March 2010 the Department of Health and Children published the National Policy - Palliative Care for Children with Life-Limiting Conditions in Ireland. In 2011 HSE South contributed to the phased implementation of the National Policy for Palliative Care for Children with Life-Limiting Conditions in Ireland by progressing the appointment of a Children’s Outreach Nurse at Cork University Hospital and Waterford Regional Hospital.
Palliative care services are organised according to a collaborative, inclusive model that incorporates care provided by generalist and specialist providers to meet population needs. The term ‘generalist palliative care provider’ refers to all those health and social care professionals who have a ‘first contact’ relationship with the person with life-limiting illness. These professionals should be able to effectively meet many of the palliative care needs of patients, their families and carers. However, a significant number of patients experience unstable symptoms or complex problems as a consequence of their illness, and, therefore, may require input from specialist palliative care services.
Based on the recommendations in the Report of the National Advisory Committee on Palliative Care 2001 and the Palliative Care Services – Five Year / Medium Term Development Framework (2009 – 2013), our goal for palliative care is to ensure that patients with life-limiting conditions, and their families, can easily access a level of palliative care service that is appropriate to their needs, regardless of age, care setting, or diagnosis. We will also ensure that a uniformly high standard of palliative care is available in all healthcare settings. In 2012 we will progress actions to meet these goals.
During 2012, the focus will be to continue to progress the implementation of agreed national priorities to develop specialist palliative care services in a structured and equitable way, building on the work done to date and in conjunction with our stakeholders. Work will continue on the roll out of the Minimum Data Set to ensure quality data to inform service management and development. This includes the development and collection of additional datasets for acute hospital, bereavement and outpatient services. The development of palliative care services will be supported by the palliative care programme within the Clinical Strategy and Programme Directorate, while continuing to drive efficiencies to ensure that services are maximised.
HSE South 89 PALLIATIVE CARE SERVICES
The priorities for the HSE South in 2012 as identified in the National Service Plan are: . Expand the provision of specialist palliative care services for adults within existing resources. . Progress the development of paediatric palliative care services. . Work with the clinical programmes to develop national standardised admission, discharge and referral criteria to increase efficiency and uniformity of care. . Support the delivery of generalist and specialist palliative care in the community through the development and implementation of evidence-based guidelines, and tailor standardised and optimised clinical pathways for generalist and specialist palliative care practitioners. . Improve collaboration with primary care teams, specifically for out-of-hours services. . Improve the quality of palliative care provision in the hospital setting and improve the environment of care for those who are dying, bereaved, or deceased. . Strengthen service user and family involvement through a national advance care planning programme to empower patients and their families to express their wishes about treatment choices and care provision towards the end of life. . Educate staff, and support research programmes in palliative care that promote evaluation and development of services, and improve approaches to care provision. . Strengthen the quality, efficiency, and effectiveness of existing service provision through the development and collection of evidence-based performance measures that support the quality improvement cycle.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Service Quantum Specialist Palliative Care services are provided directly by the HSE and in partnership with voluntary agencies via a service level agreement.
In 2012 we will provide: . 26 Specialist Palliative Care inpatient beds . 10 Community based Specialist Palliative Care teams . Specialist palliative care day care services provided in Cork and in Kerry. . Specialist palliative care services provided in nine acute hospitals throughout the South . Specialist palliative care outpatient service provided at the acute hospitals and at Marymount Hospice, Cork . 53 palliative care support beds
Cost Management & Employment Control Measures The budget reduction for palliative care services in the South amounts to €0.689m which represents a 8.6% reduction. The cost management measures necessitated by the reduced funding available for palliative care services in 2012 are summarised below. Every effort is made to ensure that the impact on services is minimised. . Reduction in Funding to Voluntary Agencies and HSE services
Service Improvements . Progress the development of 20 Bed Specialist In-Patient Unit in Waterford Regional Hospital as part of the overall national capital plan . Plan the development of the Satellite Specialist Palliative Care Unit in Kerry . Appointment of 1 Children's Outreach Nurse for Life Limiting Conditions Service for Cork and Kerry . Appointment of 1 Children's Outreach Nurse for Life Limiting Conditions Service for Waterford, Wexford, South Tipperary and Carlow / Kilkenny . Examination of staffing options . Complete needs assessment for respite facilities for children with life-limiting conditions and their families in HSE South . Develop an end of life care plan for continuing care facilities and nursing homes
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Key Result Areas The following Key Result Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Specialist Palliative Care Plan for the development of the Specialist Inpatient Units in Kerry and Waterford Q4 into 2013 Services – Inpatient Unit Develop specialist palliative care outpatient community nursing at St. Francis’ Hospice, Q4 Blanchardstown, including the provision of services to patients with non-malignant disease Paediatric Palliative Care Progress the implementation of recommendations in the national policy document Q1 Palliative Care for Children with Life-Limiting Conditions in Ireland (2009): . Implement the national Education and Governance Framework for outreach nurses for children with life-limiting conditions . Complete the national needs assessment for respite facilities for children with life- Q2 limiting conditions, and their families, in each HSE region . Complete a feasibility study on the establishment of a national database for the Q4 identification of children with life-limiting conditions under the oversight of the National Development Committee on Children’s Palliative Care . Develop a national dataset for children with life-limiting conditions Q3 . Develop a strategic plan for a children’s ‘Hospice at Home’ service model Q4 Access, Assessment of Need Develop national standardised admission, discharge and referral criteria to increase Q1 and Referral to Specialist efficiency and uniformity of care Palliative Care Services Establish and implement a benchmark for time from referral of patient to specialist Q3 palliative care services first point of contact Develop a national referral form for specialist palliative care services Q2 Develop a systematic process of assessment of need, resulting in the development of care Q4 plans for people with life-limiting conditions Integration and Governance Develop a Role Delineation Framework that defines levels of palliative care services and Q3 outlines appropriate access to services. This will facilitate strategic planning and evaluation and clearly define HSE service provision for patients with palliative care needs Develop a Palliative Care Competence Framework to support organisations across the Q4 sector in recruitment, workforce planning and development, role redesign, career progression and skill mix Complete business plan and develop implementation strategy for optimal redeployment of Q4 existing resources to meet the palliative care needs of patients Generalist and Specialist Develop and implement evidence-based guidelines and clinical pathways for generalist Ongoing Palliative Care in the and specialist palliative care practitioners Community Develop and implement guidelines and pathways to improve out of hours services Q4 Palliative Care in the Hospital Undertake a national review of the criteria and function of palliative care support beds in Q3 Setting order to determine optimal local configuration and development of these beds Design and Dignity Grant Work with the Irish Hospice Foundation on the Design and Dignity Grants Scheme in order Ongoing Scheme to assist projects that are designed to enhance the dignity of people who die in hospitals Education and Research Collaborate with the All-Ireland Institute of Hospice and Palliative Care, Education Centres Ongoing in Specialist Palliative Care Units, professional bodies, and universities, to provide programmes that ensure health and social care staff have the necessary training to better identify and respond to people with palliative care needs, to help staff initiate discussions about their preferences for care, and to enable them provide quality end of life care Involving Patients and their Support services to develop good practice in advance care planning through the Q4 Families development of national guidelines, an e-learning programme and a national recording system Promote the importance of involving families and carers in decisions about care through Ongoing advance care planning and needs assessment processes Provide organisations with readily available information on local palliative care services Q1 Provide organisations with information on how to access bereavement support services Q3 Develop Evidence-based Develop additional datasets within the National Palliative Care Minimum Dataset to collect Performance Measures data on specialist palliative care activity in: . Acute hospitals Q3 . Outpatient services Q4 into 2013 . Bereavement services Q1 Strengthen the mechanisms for the collection and analysis of data to support the Ongoing development and evaluation of palliative care services
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PALLIATIVE CARE SERVICES
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South Waiting Times Inpatient i) Specialist palliative care inpatient bed within 7 days 92% (National) 100% 100% ii) Specialist palliative care inpatient bed within 1 month 100% 100% 100% Waiting Times Community
Specialist palliative care services in the community (home care) provided to patients in their place of residence within 7 days 78% (National) 79% 79% (Home, Nursing Home, Non Acute hospital) Specialist palliative care services in the community (home care) 99% 97% 97% provided to patients in their place of residence within 1 month (Home, Nursing Home, Non Acute hospital) Inpatient Units No. of patients in receipt of treatment in specialist palliative care 62 60 60 inpatient units No. of admissions to specialist palliative care inpatient units 480 465 465
No. of discharges, transfers from the specialist palliative care inpatient unit 71 28 28 i). Discharges ii). Transfers 305 112 112 iii). Deaths* --- 270 --- Community Home Care No. of patients in receipt of specialist palliative care in the 816 866 866 community Day Care No. of patients in receipt of specialist palliative day care services 73 83 83 Community Hospitals No. of patients in receipt of care in designated palliative care 27 59 59 support beds New Patients No. of new patients seen or admitted to the specialist palliative care service (reported by age profile) 30 31 31 i). Specialist palliative care inpatient units ii). Specialist palliative care services in the community (home 171 179 179 care) NB: it is planned to develop additional indicators during the year as the palliative care clinical programme is implemented. * Outturn 2011 is actual number as reported in October 2011 Performance Report
HSE South 92
Social Inclusion Services
Introduction Resources Social Inclusion focuses on addressing health inequalities through the FINANCE – HSE SOUTH provision of specific targeted services, supporting enhanced responsiveness 2011 2012 of mainstream services and facilitating partnership and inter-sectoral Area Budget Budget working. In parallel, mechanisms for empowerment and greater participation €m €m in designing, planning, monitoring and decision making for marginalised Cork 12.750 11.930 groups and communities are put in place alongside provision of appropriate Kerry 0.491 0.459 support for staff. Carlow /Kilkenny/Sth Tipp 1.804 1.684 Poverty and social exclusion have a direct impact on the health and well Waterford/Wexford 4.198 3.950 being of the population. Vulnerable and / or people at risk may be unable to Total 19.243 18.023 access and utilise health services in a fair manner. In response to the needs of this diverse population, services are provided either directly or through WTE Ceiling – HSE SOUTH funding to non-governmental organisations, community and voluntary sector. Dec 2011 Projected Area Dec 2012 In 2012 we will progress initiatives to ensure that people in low socio- Cork 69 68 economic groupings or those affected by a range of social exclusion issues Kerry 7 7 can access and use health and personal social services when they need Carlow /Kilkenny/Sth Tipp 7 6 them. Waterford/Wexford 18 17
The National Service Plan has identified the following priorities for Total 101 98 2012: . Implement / co-ordinate a range of national social inclusion strategies and policies. These include actions in areas such as addiction services, homelessness, intercultural health, Travellers’ Health, Lesbian, Gay, Bisexual, and Transgender health (LGBT). . Continue to implement quality standards in both the statutory and voluntary-managed addiction services by enabling services to become QuADS (Quality in Addiction and Drug Services), or equivalent, compliant. . Continue to implement the National Drugs Strategy 2009-2016 actions in relation to treatment, rehabilitation and prevention. . Prioritise and implement recommendations of anticipated National Substance Misuse Strategy. . Prioritise and implement recommendations of anticipated HSE National Hepatitis C Strategy. . Implement The Way Home – A Strategy to Address Adult Homelessness in Ireland in conjunction with other key partners. . Continue to progress recommendations of the HSE National Intercultural Health Strategy 2007-2012. . Continue to progress priority actions informed by the All Ireland Traveller Health Study 2011. . Develop Health Strategy and associated Action Plan for Lesbian, Gay, Bisexual, and Transgender people (LGBT) across all appropriate care groupings. . Continue to progress priority actions agreed by the National AIDS Strategy’s Education and Prevention Sub- committee.
Embedding Quality and Patient Safety into Service Delivery Quality and Patient Safety (QPS) will continue to be embedded into service delivery by the active participation of representative staff in the Area QPS committees, Patient Safety Culture survey, HIQA National Standards preparation, prevention of healthcare associated infections, incident management and continuous updating of the facility’s risk register. The service will continue to promote service user involvement in committees and decision making.
Service Quantum HSE South Social Inclusion services improve access to mainstream services, target services to marginalised groups, address inequalities in access to health services and enhance the participation and involvement of socially excluded groups and local communities in the planning, design, delivery, monitoring and evaluation of health services. In 2012 we will provide:
Drug and Alcohol Services . 7,500 treatments for substance misuse, an increase of 2,000. This reflects additional service developments in 2011 . 22 community based detoxification beds . 115 residential rehabilitation beds, an increase of 2 beds HSE South 93 SOCIAL INCLUSION SERVICES
. 28 step down beds
Homeless Services . 766 beds/units in 41 homeless facilities in HSE South . 7 women’s facilities/refuges . 8 emergency men’s hostels . 18 transitional /supported living facilities . 8 long term residential facilities.
Traveller Services . 2 Traveller Health Units. . 12 Traveller Primary Healthcare projects . 48 Traveller Community Health Workers . 4 Traveller Men’s Projects
Cost Management & Employment Control Measures The budget reduction for social inclusion services in the South amounts to €1.22m which represents a 6.3% reduction. Efficiencies will be achieved in non pay expenditure in core budgets and regional committee core budgets. In addition, there will be some reduction in Voluntary Agencies funding.
Service Improvement 2012 . Roll out of Needle Exchange Programme . Development of HSE South Harm Reduction Policy . Roll out of Nurse Prescribing in Addiction Services . Continued implementation of Rehabilitation Strategy . Commencement of QUADS . Review of Electronic Patient System . Review of Clinical Governance Model . Implementation of Community Development Project mainstreaming initiative . Enhancement of Homeless Action Team (HATs) . Development of combined Homeless Tenancy Outreach Support and Mental Health Outreach Support Service in Cork . Roll out of Traveller Screening Initiatives . Pilot initiative re Diabetes and Cardio-vascular Disease in the south east. . Pilot healthy lifeskills training in men’s hostels in south east . Roll out of Key Worker initiative.
Key Result Areas The following Key Result Areas (KRAs) have been included in the National Service Plan for delivery in 2012:
Target Completion Key Result Area Deliverable Output 2012 Quarter Addiction Services Implementation of the National Drugs Strategy (NDS) 2009-2013 Implement recommendations from HSE Opioid Treatment Protocol: . Establish a national data collection, collation and analysis group to maximise the use Q1 of current data, identify new data, and develop a brief outcome monitoring process for individuals . Develop joint clinical guidelines on the treatment of opioid addiction across the full Ongoing range of drug services by the ICGP, ICP, PSI and the HSE. The guidelines will include an implementation plan for the move to less urine testing and a greater clinical focus on the use of the results of drug testing samples
. Produce a quarterly analysis report on Methadone Waiting list Ongoing . Produce a quarterly analysis report on exits from the Methadone Treatment list Q2-Q4 Implement Report of the Working Group on Residential Treatment and Rehabilitation (Substance Users) 2007 and HSE National Drugs Rehabilitation Framework 2010: . Conduct an analysis of HSE’s National Drugs Rehabilitation Framework for Q4 usefulness for the following groups: service users, case managers, key workers within other disciplines and service managers
. Measure client care plan progression over the course of 2012 Q4 . Identify the barriers that hinder care planning / case management at the systemic and Q4 individual client level HSE South 94
SOCIAL INCLUSION SERVICES
Target Completion Key Result Area Deliverable Output 2012 Quarter Prioritise and implement HSE actions in the National Substance Misuse Strategy, following its publication: . Develop an annual training plan which targets emerging trends in addiction and Q1 reflects best practice via the HSE National Addiction Training Programme . Implement Quality Standards (Quality in Addiction and Drug Services, QuADS) in Ongoing both the statutory and voluntary-managed addiction services . Conduct an effectiveness review exercise on all current forms of needle exchange Q4 provision currently funded by the HSE . Launch an Alcohol Public Education / Awareness Campaign Q1 . Further develop web based information and awareness systems for addiction Q4 . Develop a national drug and alcohol service directory to include in-depth information Q3 on treatment and rehabilitation and geo-mapping for staff and service (linked with HSE Health Intelligence Unit and Health Atlas) Homelessness Implement The Way Home – A Strategy to Address Adult Homelessness in Ireland in conjunction with other key partners: Ongoing . Agree interagency referral and care pathways between in-reach and targeted health services for homeless people, travellers and other social inclusion targeted groups, and mainstream health services in community and hospital settings . Ensure that the existing care plan / key worker system is operating effectively to Ongoing support the introduction of the proposed care and case management approach across the homeless services sector
. Review existing discharge protocols for homeless persons leaving acute care in each Q2 operational area to ensure that the recommended practices of the HSE Code of
Practice for Integrated Discharge Planning are fully implemented Intercultural Health Implement recommendations from the HSE National Intercultural Health Strategy: . Enhance accessibility, improve data and support staff in ensuring culturally competent service delivery Ongoing . Extend the roll out of the ethnic identifier to capture key health information of minority Q2 ethnic groups in each HSE region . Develop a national database to support staff in accessing and developing appropriate Q4 translated health related material Traveller Health Progress delivery of recommendations in the All-Ireland Traveller Health Study, with Ongoing particular reference to those priority areas identified such as mental health, suicide, men’s health, addiction / alcohol, domestic violence, diabetes and cardiovascular health LGBT Health Finalise and launch Health Strategy and Action Plan for LGBT people Q1 Develop LGBT health specific actions in respect of identified priority areas such as Q4 transgender health, mental health and lesbian health National Hepatitis C Implement prioritised, resource neutral recommendations of HSE National Hepatitis C Q2-Q4 Strategy Strategy once published HIV / AIDS Deliver a social marketing campaign on HIV prevention and decrease in the rate of HIV Q4 infections
Performance Activity and Performance Indicators The performance activity and indicators have been included in the National Service Plan for delivery in 2012:
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South Methadone Treatment No. of clients in methadone treatment (outside prisons) 275 323 350 No. of clients in methadone treatment (prisons) 500 (National) 564 (National) 520 (National) Substance Misuse No. and % of substance misusers (over 18 years) for whom --- 604 1,260 treatment has commenced within one calendar month following 100% (National) 99% 100% assessment (National) No. and % of substance misusers (under 18 years) for whom --- 46 105 treatment has commenced within two weeks following assessment 100% (National) 94% 100% (National) Homeless Services HSE South 95
SOCIAL INCLUSION SERVICES
Expected Activity / Expected Activity / Projected Outturn 2011 Target 2011 Target 2012 South South South No. of individual service users admitted to statutory and voluntary New PI for 2011 386 386 managed residential homeless services who have medical cards 75% 89.6% --- No. and % of service users admitted to homeless emergency --- New PI for 2012 80% (National) accommodation hostels / facilities whose needs have been formally assessed within one week No. and % of service users admitted to homeless emergency --- New PI for 2012 80% (National) accommodation hostels / facilities who have a written care plan in place within two weeks Needle Exchange No. of pharmacists recruited to provide Needle Exchange --- New PI for 2012 45 in Q1 (National) Programme 65 in Q3 (National) Traveller Health Screening No. of clients to receive national health awareness raising / --- New PI for 2012 1,650 (National) screening programmes (breast check, cervical smear screening, 10% proportion of targeted men’s health screening, blood pressure testing) delivered through population in each region the Traveller Health Units / Primary Health Care Projects
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Appendix 1 Financial Information
2012 Budget INTEGRATED SERVICES/ OPERATIONAL AREA € Cork Integrated Services Area Cork University Hosp 233.483 Bantry General Hospital 15.738 Mallow General Hospital 15.481 Ancillary Services 2.597 Network Mgr 12.000 Mercy University Hospital 50.997 South Infirmary Victoria Hosp 42.386 North Lee 91.949 South Lee 86.637 North Cork 72.178 West Cork 210.434 Cork Dental Hospital 1.787 Cork ISA Total 835.667 Waterford / Wexford Operational Area Waterford Regional Hospital 126.709 Wexford General Hospital 44.164 Regional Acutes 2.053 Network Manager 1.285 Wexford 84.900 Waterford 104.275 Waterford / Wexford OA Total 363.386 Carlow / Kilkenny / South Tipperary Operational Area St. Luke’s Hospital/ Kilcreene 51.662 South Tipp General Hosp 42.469 South Tipperary 86.931 Carlow /Kilkenny 118.353 SE Regional PCSS Services 1.273 Carlow / Kilkenny / South Tipperary OA Total 300.688 Kerry Integrated Services Area Kerry General Hospital 65.162 Kerry 91.063 Kerry ISA Total 156.225 Unallocated Regional Services 17.465 RDO/HR 16.524 RDO Total 33.989
Total 1,689.955
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Appendix 2 HR Information
WTE Ceiling vs Actual No. of WTEs in HSE South at end of December 2011 – by Service
Ceiling End Actual End HSE South WTE - Service Plan 2011 December December Variance 2011 2011 Acute Hospital Services 10,437 10,623 186 Ambulance Services 416 410 (6) Primary and Community Services 11,688 11,444 (244) Portion of Ceiling to be allocated 176 0 (176) ISD 22,717 22,477 (240) Corporate 681 667 (14) QCC/Population Health 267 259 (8) HSE South 23,665 23,403 (262)
No. of WTEs in HSE South at end of December 2011 – by Grade
Actual End HSE South Grade Category December 2011 Medical/ Dental 1,812 Nursing 8,538 Health & Social Care Professionals 3,392 Management/ Admin 3,203 General Support Staff 2,865 Other Patient & Client Care 3,593 Total 23,403
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Impact of Moratorium and Exit Schemes in HSE South – by ISA / Service / Grade
Retirement / Resignations VER/VRS ISA Area / Grade WTE Headcount WTE Headcount Cork ISA Medical/Dental 2.9 5 Nursing 147.48 180 Health and Social Care Professionals 12 14 Management/Admin 16.14 23 47.51 58 General Support Staff 23.84 32 44.32 49 Other Patient and Client Care 24.39 33 Cork ISA Total 226.75 287 91.83 107 Kerry ISA Medical/Dental .17 1 Nursing 40.99 49 Health and Social Care Professionals 3.9 4 Management/Admin 2.95 4 15.4 19 General Support Staff 7.21 9 10.62 14 Other Patient and Client Care 4.01 5 Kerry ISA Total 59.23 72 26.02 33 Waterford / Wexford Operational Area Medical/Dental 1 1 Nursing 80.5 98 Health and Social Care Professionals 13.77 15 Management/Admin 10.13 13 32.93 37 General Support Staff 17.21 33 35.45 45 Other Patient and Client Care 6.19 9 Waterford / Wexford Operational Area Total 128.8 169 68.38 82 Carlow/Kikenny/South Tipperary Operational Area Medical/Dental .5 1 Nursing 80.15 96 Health and Social Care Professionals 5.4 6 Management/Admin 11 14 36 40 General Support Staff 21.48 28 38.61 44 Other Patient and Client Care 10.62 18 Carlow/Kilkenny/South Tipperary Operational Area Total 129.15 163 74.61 84 Corporate and QCC / Population Health Corporate 8.63 9 33.08 36 QCC / Population Health 5.66 7 3.1 4 TOTAL HSE SOUTH 558.22 707 297.02 346
Impact of Moratorium and Exit Schemes in HSE South – by ISA / Service / Grade
Retirement / Resignations VER/VRS ISA Area / Grade WTE Headcount WTE Headcount HSE South Medical / Dental 6.72 11 HSE South Nursing 250.62 318 HSE South Nursing (Mental Health) 99.5 106 HSE South Health and Social Care Professionals 36.07 40 HSE South Management/Admin 46.22 60 162.52 188 HSE South General support Staff 72.37 105 133.5 157 HSE South Other Patient and Client Care 46.72 67 1 1 Total All Grades - HSE South 558.22 707 297.02 346
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APPENDIX 3
Appendix 3 Health Sector PSA Implementation Plan
Summary description of HSE South Health Service Initiatives The Public Service Agreement 2010-2014 will ensure that the Irish Public Service continues its contribution to the return of economic growth and economic prosperity to Ireland. This will be done by working together to build an increasingly integrated Public Service which is leaner and more effective, and focused more on the needs of the citizen. The Parties to this Agreement recognise that to achieve this, in the context of reduced resources and numbers, the Public Service will need to be re-organised and public bodies and individual public servants will have to increase their flexibility and mobility to work together across sectoral, organisational and professional boundaries.
Public Service Agreement: Summary list of initiatives This document sets out a summary list of the agreed Public Service Agreement initiatives for the Health Sector at two levels; . National: National priorities that will be delivered in a standardised way across the country (in accordance with principles agreed in the PSA) . Regional: Initiatives specific to each region/ locality (in accordance with national priorities)
The list of initiatives provides summary information including; . PSA reference number. . A one line summary of the change proposed. . The PSA measure the initiative addresses. The list of 15 measures is set out in the next column. . The sponsor for each initiative (National Director/Assistant National Director/ RDO). . 1The timeframes associated with implementation . The impact on staff in terms of type of staff, numbers redeployed or reduced etc. . The impact on services and the targeted benefits
*Targeted benefits would include both qualitative and quantitative measurements, e.g. reduction in head count, monetary savings, productivity improvements, safeguarding quality of service, clinical performance, service delivery timeframes – faster access to services, better health outcomes, more cost efficient services, expansion of roles and direct referral pathways for all professionals.
Public Service Agreement: Measures 1. Redeployment/ reassignment 2. Integrated Patient Centred Care 3. Changes to Organisational Structures 4. Multi-disciplinary working and reporting (to extend beyond professional boundaries particularly in community services) 5. Non Pay cost reductions - via partnership 6. Revised cross cover and on-call tier reductions for example with NCHD grades in achieving compliance with EWTD. 7. Risk/Quality/Safety - better management (protocols, audit, care pathways, etc) 8. Evidence based performance measurement- drive continuous improvement efficiency / effectiveness 9. Merit based and competitive promotion policies 10. Strengthening individual, professional and statutory accountability for senior managers and clinicians 11. Centralisation of functional, transactional, support services and other services 12. Extended Working Day (8am-8pm) – where identified to meet service requirements 13. Extended working arrangements up to and including 24/7 emergency services – where identified to meet service requirements 14. Rostering arrangements including skill mix – to achieve the optimal match between staff levels, service activity levels and patient dependency levels across the working day/ week/ year 15. Medical Laboratory Service Modernisation
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APPENDIX 3 PSA Initiatives – Cork Area
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Cork PCC Mental Health Revised rostering arrangements, introduction of skill mix and Q2 1,2,14 comprehensive structured annual leave Cork PCC Mental Health Within a comprehensive 24 hour integrated management Q2 1,2, 14 model implementation of revised nurse management arrangements at night
Cork PCC Mental Health Expansion of community based services, including CMHGs, Q3 1,2,4, 7, 8, 13,14 access to home based treatment and role out of community based model of care in line with VFC. Alignment of acute inpatient bed numbers with norms in VFC and associated staff reassignments Cork PCC Mental Health Introduction of expanded risk assessment protocols in On-going 7 community settings Cork PCC Mental Health Participation in training On-going 7 Cork PCC Mental Health Participation in development and implementation of care On-going 4,7, 8 pathways Cork PCC Disability HSE services - Revised rostering arrangements, introduction of Q1 1,2,14 skill mix and comprehensive structured annual leave Cork PCC Older People Implementation of Home Help hours target hours in line with Q1 1, 13 2012 target levels Cork PCC Older People Review and implement findings on staffing levels, rostering and Q1 1,2, 4, 14 skill mix in all hospitals Cork PCC Older People South Lee - St. Finbarr's Hospital – Changes in work practices Q2 1,2,4, 7,8,14 for establishment of a New Rapid Access Elderly Care referral OPD clinic in A&TC. Cork PCC Older People South Lee - St. Finbarr's Hospital - Changes in work practices Q1 1,2,4, 8,14 for Establishment of a 10 bedded designated Stroke Rehabilitation service Cork PCC Older People Midleton Community Hospital - Medication Review System to On going 4 ,7 be introduced by MDT at Midleton Community hospital to ensure the most appropriate therapeutic medication intervention are used for residents at the hospital. Cork PCC Older People Dunmanway Community Hospital - Pilot programme on Q4 performance coaching / management for all staff at Dunmanway Community Hospital to be carried out. Cork PCC Older People South West Cork Community Hospitals - Continence Wear Q4 5 Initiative. Staff at Castletownbere Community Hospital who have been trained in continence management will deliver a 2 day training programme to staff in the other community hospitals in the area. Cork PCC Older People North Lee / North Cork – changes in models of service deliver Q2 2,5, 7,8 for Wound Care Clinics Cork PCC Older People North Lee / North Cork - Podiatry: Working in partnership with Q1 2,5,7 voluntary groups on pilot initiatives to target high risk diabetic patients in conjunction with Diabetes Federation of Ireland, including access to hospital laboratory facilities, vascular services, etc. Cork PCC Children and Eliminate (Reduction +/- ) agency spend in Child Residential Q1 1,2,4, 14 Families Unit through implementation of recommendations of independent review of fostering arrangement and revised rostering arrangements, introduction of skill mix and comprehensive structured annual leave Cork PCC Children and North Lee / North Cork - School vaccination & HPV vaccination Q2 1,2,5, 7, 8,11 Families clinics to be centralised in a number of locations CUHG Hospital Services CASS Project Phase 1: Reorganisation of Clinical Q1 Administration Support Services - Medical and Surgical 1, 3, 11
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Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Services. This involves a change in both work processes and administrative structures to maximise staff resources through centralisation of functions where possible. Restructuring and staff reassignment is also in line with pending clinical directorate restructuring and national OPD projects including the GP Referral project. DDVR Technology: The introduction and piloting/utilisation of Digital Dictation and Voice Recognition technology in selected areas is a complementary aspect of this project. CUHG Hospital Services CASS Project Phase 2: Reorganisation of Clinical Q2 1, 3, 11 Administration Support Services. This involves monitoring and review of Phase 1 and an assessment of the potential for reorganisation and reassignment within the remaining clinical areas and the wider clerical/administrative grouping. CUHG Hospital Services Dietetics: Introduction of insulin pumps for diabetic children; Q1 2, 4 integrated hospital and community outreach diabetes services based in Mallow hospital CUHG Hospital Services Physiotherapy: Reorganisation of service delivery pilot with Q4 1, 2,14 senior physiotherapist in CUH A&E operating as a first contact practitioner in Mercy A&E. Proposal submitted regarding the introduction of Physiotherapy assistants in CUH through retraining. CUHG Hospital Services Radiation Oncology Services: Introduction of 10-6 pm shift for Q4 2,5, 13 2 machines in radiotherapy; weekly QA moved to pre-9am; Introduction of electronic booking process and E charts. CUHG Hospital Services Medical Records: Changes to ward plan and the introduction Q4 1, 2,5 of paperless diagnostic results providing scope to reassign staff resulting from efficiencies. Policy to support movement of charts between hospitals. Enhanced use of technology to view all patient records. CUHG Hospital Services Medical Physics: Service improvements including the Q4 2,7 introduction of a brachytherapy prostate seed program for prostate cancer patients and an Intensity Modulated Radiation Therapy program for cancer patients. Process and Safety improvements including exploring new way of delivering treatment planning service with NCCP; Introduction of Q-Pulse for departmental policies and procedures; Monitoring of eye doses for staff involved in logical Interventional procedures. CUHG Hospital Services Procurement: Point of use stock management through the Q4 5 utilisation of Kanban Stock Management Systems. CUHG Hospital Services Laboratories. ICT and Work Process Improvements and Staff Q4 1, 5 Reorganisation: Development of integrated electronic databases, tracking and ordering systems, fully auditable electronic POCT service, and LEAN based procedures and processes - facilitating integration and more efficient deployment of staff. CUHG Hospital Services CUMH: Reorganisation of work areas and reorganisation of Q4 1, 3 work/staff to maximise resources - including in OPD and reception areas. CUHG Hospital Services OPD: Development of Work Processes and Procedures and Q4 1, 2,3, 5, 7, 11 Reorganisation of Clerical/administrative support services to facilitate efficiency improvements, the centralisation of functions, and the implementation of changes in line with national OPD initiatives and reorganisation of acute services including: Central Referral and Appointment management/scheduling; Central waiting list validation and management; Streamlining and consolidation of clinic preparation, management and delivery under single Governance; Dedicated neurology rooms in line with National HSE South 102
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Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Neurology clinical care programme; Incorporation of additional new consultant led clinics within existing resources. Participation in pilot for new national GP referral project. Working with SIVUH in relation to the functioning of incoming OPD-related cardiac services under reorganisation. CUHG Hospital Services Acute Medical Unit: Implementation of medical assessment Q4 1,2, 3, 4,7 component in Q1 2012 with the introduction of acute surgical assessment to follow in Q2 2012 and further compliance to the National Clinical Care Programme. Involves the internal deployment of staff and skill mix opportunities CUHG Hospital Services Implement the directorate model for the CUH group with clinical 1, 2,3, 4, 7, 10 directors etc. CUHG Hospital Services Nursing & Midwifery Rosters: Extension of the ED Q4 1, 2, 14 Computerised nurse rostering system to allow improved utilisation of the nursing resource. Pre-Operative Assessment to facilitate same day admission for surgery and increase bed management efficiencies. CUHG Hospital Services Pharmacy Services: Assess the possibility of repatriating an Q4 5 element of the current compounding services into the Hospital CUHG Hospital Services Radiology Services: Implementation of the Labour Court 6, 12 recommendations CUHG – Hospital Services Mallow General Hospital: Implementation of the re-organisation Q4 1,2,3,7,10,14 MGH of services for acute Hospitals including emergency care, elective surgery and diagnostics CUHG – Hospital Services Medical Roster Revision -Reduce Intern out of hours and Q1 6 MGH reduction in reliance of Medical Registrar agency plus no consultant physician cover upon commencement of 4th consultant physician CUHG – Hospital Services Pathology Restructuring Q2 1,15 MGH MUH Hospital Services Centralised administrative support service Q4 1, 2, 5,11 MUH Hospital Services Implementation of the national Radiography agreement Q3 6 MUH Hospital Services Implementation of the Acute Medicine Programme in Q2 1,2,7 accordance with the National AMP Recommendations, in addition to the final outcome of the GIM Working Group.
BGH Hospital Services Radiography Department - Implementation of the Labour Court Q4 12, 13 recommendations BGH Hospital Services Review staffing arrangement in the Nursing Department, Non Q4 1,2,14 Nursing & Administration Revised rostering arrangements, reassignment introduction of skill mix and comprehensive structured annual leave, BGH Hospital Services Review of catering services including meal times for patients Q4 5,14 and serving system All service areas Management / Administrative functions - re-configuration and 2012 1,2,3,5,11, 14 reassignment of management & administration, local manpower planning to be undertaken to maximise efficiencies through revised working arrangements and introduction of IT Cork PCC Primary Care Reassignment of South Lee SLT Manager as SLT Manager for Q1 17 Cork South Cork PCC Primary Care Delivery of community SLT to adult clients to transfer to the Q1 2,3 Assessment & Treatment Centre (ATC) in St. Finbarrs Hospital. Cork PCC Primary Care SLT - Joint working and sharing caseloads across Clonakilty Q2 2, 3 (West Cork) and Bandon (South Lee) in delivery of Parent training programme for late talkers. Cork PCC Primary Care SLT - Introduction of new protocol for recording staff diaries Q1 7 and facilitating robust mechanism for management of client
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Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 appointments in West Cork Cork PCC Primary Care Wait list initiative for paediatric OT service West Cork Q3 2. 8 Cork PCC Public Analyst Organisation of a specialised Analytical Chemistry Service in On going 3,7,8 Lab collaboration with the FSAI and Dublin & Galway Public Analyst's Laboratories Cork PCC Public Analyst New Food Sampling and Analysis Programme agreed with On going 7 Lab FSAI and EHS in December 2011 in use from January - December 2012 Cork PCC Public Analyst New Cosmetics sampling and analysis programme agreed in On going 2,7 Lab December 2012 between the EHS and IMB for use from January - December 2012. Cork PCC Public Analyst Continued collaboration with the IMB and EHS on cosmetics On going 2 Lab monitoring and reaction to consumer alert notifications relating to chemical contaminants in cosmetics. Cork PCC Public Analyst Multi-parameter chemical analyses of food samples to On going 2 Lab continue In 2012 ( new areas identified for multi-parameter testing). Cork PCC Public Analyst Continuation of 2011 DEMOCOPHES programme involving Q2 2 Lab mercury analyses of hair samples from participants in the programme in Dublin and Leitrim Cork PCC Public Analyst Identification of new analytical methods for food and water On going Lab monitoring Cork PCC Public Analyst Identification and development of new analytical methods for On going 2 Lab cosmetics monitoring Cork PCC Public Analyst Validation of new analytical methods for food and water On going 2 Lab monitoring Cork PCC Quality and Public Health Microbiology Laboratory, SFH - Extension to Q4 2, 7 Safety INAB scope of accreditation Cork PCC Quality and Public Health Microbiology Laboratory, SFH - Collaborating Q3 7 Safety with other official food microbiology laboratories at a national level to devise a standard reporting format for results Cork PCC Quality and Public Health Microbiology Laboratory, SFH - Collaborating Q3 7 Safety with other official food microbiology laboratories at a national level to devise a standard test suite Cork PCC Quality and Public Health Microbiology Laboratory, SFH - Development of Q4 2 Safety microbiological testing services for therapeutic waters from hospitals in the region (previously outsourced) Cork PCC Primary Care South Lee PHN Service - Due to available resources Q1-Q4 1, 2,3, 6, 16 restructuring of areas was carried out into defined area teams with a balanced skill-mix to enable services to be prioritised and delivered in an effective and timely manner and to ensure that the clinical risk to both patient and staff is minimised. Ongoing Cork PCC Primary Care South Lee PHN Service - Integration of the New Born Hearing Ongoing 2, 4, 7 Screening Protocol to the Home Birth Service to ensure a seamless referral system incorporating all community births. Cork PCC Management Centralising and merging of administrative departments such Q4 1,2,14 and as immunisations staff with asylum seekers and clinic A staff to Administration provide cross cover during leave. This will enable cross cover Function, South arrangements within the available resources including the Lee provision of clerical support to HPV Ongoing reviews of work practices in this area to achieve efficiencies, cover and improved staff satisfaction. ongoing. Cork PCC Care group Limited resources available – reviewing existing processes Ongoing 5 children, throughout childcare manager’s office, Pathways and social Management work – have identified options in relation to improved filing of and closed files, a new approach to archived files ( potential
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APPENDIX 3
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Administration savings identified) other process also under review. Function South Lee Cork PCC Management Reconfiguration of management structure in Cork ISA into two Q1-Q4 1,2,3,4,7,8,10,11, and operational areas and teams. 14 Administration Function South Lee and West Cork Cork PCC All care groups - Assessment and realignment of administrative supports Q1-Q4 1,2,11, 14 Cork South moving into primary care team and network structures. Cork PCC All care groups - Review and realign current standing committee structures Q1-Q4 2 Cork South including RAGs, Early Intervention fora etc. to streamline allocation processes. Cork PCC All care groups, Commence work on reconfiguring schemes and financial Q1-Q4 5,11 Schemes support functions across Cork ISA including payroll. Department, financial support Cork PCC Older persons, Home Support Manager roll to be rolled out across Cork South Q1-Q4 1,2,7,8 disability - Home Support Service Cork South Cork PCC Care group older Home Support Function to be reorganised and the Home Q1-Q4 1,2,5,7,8 persons, Support Manager to take on West Cork home support services disability. Home remit. This department will also continue to roll out the National Support Home Care Package Guidelines. The staff also monitor HCPs Department and assisted living services. South Lee Cork PCC All care groups - Establish liaison with Acute Services with regard to discharge Q1-Q4 2,8 Cork South planning where home supports are required. Cork PCC Disability Streamlining and centralising Assessment of Need (Disability Q1-Q4 2,7,8 Act) process across Cork ISA – one central point of application. Cork PCC Primary Care Reconfigure OT and Physiotherapy departments across Cork Q1-Q4 1,2,4,8 ISA to ensure rotation of students across whole county. Cork PCC All care groups Service contracts manager – focus on streamlining processes Q1-Q4 2,3 4,5,11 (except mental for SLA and GA, also elimination of duplication and ensuring health) - Cork consistency of approach to voluntary sector providing services South under s.38 and 39 of the health act. Cork PCC Cork South Streamlining of staff working areas through LEAN Project to On-going 1,3,5 General ensure easy accessibility and cross cover Manager’s Office Cork PCC Cork South Updating of filing systems currently in place through LEAN Complete/On- 5 General Project to ensure accuracy of records stored and archiving of going Manager’s Office old files Cork PCC Cork South Streamlining of general office area through LEAN Project to Complete/On- 5 General ensure all structures are easily identifiable and accessible going Manager’s Office Cork PCC Primary Care Out patient Occupational Therapy assessments and treatments Q1-Q4 2,4,8 now available in new OT Assessment centre including Hand Injury Clinic, Wheelchair and seating assessments, Wheelchair repair clinic, Initial community assessments, Community Mental Health Assessments Cork PCC Disability Pilot Reconfiguration of clinical management structure in HSE Q1-Q4 1,3,7 Services Cork residential ID services in response to changing staff resources Cork PCC Disability Appropriate reassignment of admin/ management resources Q1-Q4 1,2,7 Services to support regional co-ordination of services Cork PCC Primary Care Currently reconfiguring all West Cork PHNs and Community Q1-Q4 1,2,4,7,8,14
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APPENDIX 3
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Nurses in line with Primary Care Geomapping. Home Help Coordinators and Asst Directors of PHN already reconfigured Cork PCC Older persons All Public Health Services are reconfigured to Primary Care Q1-Q4 2,11 Teams. Each Network with an Assistant Director for line manager. Cork PCC All care groups - Wound Clinics are run by a Clinical Nurse Specialist and Pre Q1-Q4 2,8 PHN services diabetes clinics are run in all Primary Care teams and available to all. Cork PCC Leased premises Assessment of current leased premises HSE South to Q1-Q4 5 maximise value for money Cork PCC All care groups - Examine related budget, product and processing to achieve Q1-Q4 5 PHN Supplies, value for money, economies of scale and savings Cork ISA Cork PCC All care groups - Examine incontinence wear products, budget, governance and Q1-Q4 5 Incontinence processes with a view to achieving VFM, best practice and Wear, Cork ISA savings Cork PCC St. Finbarrs St. Finbarr's Hospital - Change to rostering arrangements – Q1 1,2,13,14 Hospital Assessment &Treatment Centre to include later finish times to extend OPD clinics Cork PCC St. Finbarrs St. Finbarr's Hospital - Establishment of a New Rapid Access Q2 1,2,13,14 Hospital Elderly Care referral OPD clinic in Assessment &Treatment Centre Cork PCC St. Finbarrs St. Finbarr's Hospital - Alteration of MTA rostering Q3 1,2,14 Hospital arrangements to maximise contact time with hospital inpatient services - elimination of accrual of additional hours Cork PCC St. Finbarrs St. Finbarr's Hospital - Establishment of a 10 bedded Q1 1,2 ,14 Hospital designated Stroke Rehabilitation service
PSA Initiatives – Kerry Area
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Kerry Mental Health Revised rostering arrangements, redeployment of staff, Ongoing from 1,2,14 PCSS introduction of skill mix and comprehensive structured annual 2011 Service leave, supported by IT Plan
Q1-Q2 Kerry Older People Implementation of Home Help hours target hours in line with Q1- ongoing 1,13 PCSS 2012 target levels Kerry Older People Review of service provision across all community hospital Ongoing from 1, 2, 14 PCSS services - Revised rostering arrangements & review skill mix to 2011 Service maximise bed usage & reduce reliance on agency staffing. Plan
Q1-ongoing Kerry Older People Reconfiguration of PHN & RGN staff to ensure core elements Q1-ongoing 1, 2 PCSS of service are provided, with the reduced staffing levels KGH Hospital Medical - reduction in Consultant Locums in the following areas Q1-Q4 6 Services * General Surgery, Medicine, Anaesthetics KGH Hospital All services– Revised rosters, introduction of skill mix, and Q1-Q4 1,2,5,8, 13,14 Services assignment flexibility e.g. in Phlebotomy, Laboratory, Portering, HSE South 106
APPENDIX 3
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Catering, Radiology, Cleaning, CSSD
KGH Hospital Nursing - Revised rostering arrangements, introduction of skill Q1 -Q4 1,2, 14 Services mix and comprehensive structured annual leave KGH Hospital National Clinical Programmes – changes in models of care and Q1-Q4 1,2, 7,8,14 Services introduction of revised rosters, skill mix and assignments to implement the clinical programmes and achievement of performance targets established by SDU KGH Hospital Divisional Structures – reorganisation of service delivery model Q4 1, 3,4, 10 Services to an integrated divisional structure, to improve clinical governance within the hospital KHA All service areas Management / Administrative functions - re-configuration and Q1-Q4 1,2,4,5,7,8 reassignment of management & administration, local manpower planning to be undertaken to maximise efficiencies through revised working arrangements, and introduction of IT
PSA Initiatives – Waterford / Wexford Area
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Wexford Mental Health Continuation of implementation of VFC - restructuring and Q1 3,14 LHO reorganisation in the Wexford area Wexford Mental Health Development of out-reach clinics for Child & Adolescent Psychiatry Q1 2 LHO Services Wexford Mental Health Redeployment/Reassignment of staff from Wexford Mental Health Q4 1,3,14 LHO Services with closure of wards in St. Senan's and transfer to new development 'Tus Nua', Enniscorthy. Wexford Mental Health Revised cross cover and on-call tier reductions - NCHDs removed Q1 6 LHO from on-call on week-ends to become more compliant with EWTD Wexford Mental Health Reassignment of support staff to other patient focus roles e.g. Q1 1,4, 14 LHO Occupational Therapy Aide duties Wexford Mental Health Support development and participation in Consumer Panel for Q3 2 LHO Waterford/Wexford Mental Health Services in to have more patient centred care Wexford Mental Health Development of Key Worker role- provision of information to clients Q4 2 LHO regarding services Wexford Disability Relocation of clients and staff to new house, 12 Km approx from Q1 1,3, 14 Residential ID Enniscorthy. Involving revised rosters Services Wexford Disability Closure of Day Services attached to St John of God House, Q1 1,3,14 Residential ID Enniscorthy with relocation of clients and staff to the new Millbrook Services Day Centre, 1 Km approx from original service. This also involved implementation of new rosters Wexford Disabilities Redeployment of DSA as Coordinator Early Intervention Services Q1 1 LHO and expansion of role. Improved multidisciplinary team working re Autism Spectrum Disorder and Early Intervention Team Wexford Residential ID Provision of Catering Services by St John's Hospital Catering Q1 11 LHO Services Service to 6 residential homes and 1 day centre for people with intellectual disabilities within existing resource Wexford Older People Provision of on call service by Home Help Coordinators for 2 Q1 13 LHO months to support the SDU during December & January. Second
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APPENDIX 3
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 call provided by General Manager & TDO Wexford Older People Redeployment of staff to meet service level needs in St. John's Q1 1 LHO Community Hospital Wexford Older People Review of rostering arrangements including skill mix to maintain Q1 1, 14 LHO ongoing service provisions Wexford Older People Reassignment of range of duties nursing & portering staff in New Q1 1, 14 LHO Houghton Hospital Wexford Children & Redeployment of DSA as Clerical officer to Support the Q1 1 LHO Families Immunisation Team Wexford Children & Relocation of breast feeding support clinic from rented premises to Q1 5 LHO Families Ely Hospital Wexford Primary Care Relocation of medical, nursing, clerical & EHO staff with closure of Q1 1,14 LHO St John of God House and part of St Senan's Hospital to other part of St Senan's Hosp Wexford Primary Care Workforce Planning within Physiotherapy Services to improve Q1 2 LHO productivity per clinical area Wexford Primary Care Improved services to patients with chronic conditions within Q1 1, 2 LHO Physiotherapy Services with provision of “back school” in Wexford County Wexford Primary Care Redeployment of Physiotherapy staff to address backlog in Waiting Q1 1 LHO list Wexford Primary Care Extension of services to GPs within existing resources involving Q1 2 LHO Acute and Non acute service providers Wexford Primary Care Development of chronic knee programme within Physiotherapy Q1 1,8 LHO services - evidence based within existing resources Wexford Primary Care Further development of new role of Physio Therapy Manager 3 to Q1 1, 2, 3 LHO manage acute and non acute services in Co. Wexford within existing resources Wexford Primary Care Review of patient registers in the 4 sectors, validation of waiting Q1 2,7, 8 LHO lists, improved data collection mechanisms to enable service delivery analysis Wexford Primary Care Expansion of Home Care Packages to week-ends - extended Q1 1,13 LHO working arrangements to include Saturday work Wexford Primary Care Expansion of Primary Care teams, enhanced multi-disciplinary Q1 1, 2,4 LHO working, relocation of staff to other premises Wexford Primary Care Assessment of Need for Psychology within Primary Care - Q1 1, 2 LHO redeployment of staff Wexford Primary Care Development of a register for XPERT (Dietic Programme) for Q1 1 LHO Wexford within existing resources Wexford Primary Care Enhanced ICT provision through provision of software and training Q1 7, 8 LHO towards evidence based performance measurement Wexford Primary Care Multi-disciplinary working to improve integrated patient centred Q2 1, 2, 7 LHO care, development of seminar for GPs and Pharmacists to improve Team Working with Substance Misuse team Wexford Primary Care Developing Community Engagement Programme Q2 2 LHO Wexford Primary Care Commencing process of Community Needs Assessment within Q2 2,4 LHO Primary Care Wexford Primary Care Provision of Enuretics clinics - within existing resources Q1 2 LHO Wexford Primary Care Reassignment of staff to service level needs within Public Health Q1 1 LHO Nursing Services Wexford Primary Care Rationalisation of Health Centres and relocation of staff to central Q1 1,11 LHO services WRH Hospital Revised rostering arrangements, introduction of skill mix and Ongoing 14 Services comprehensive structured annual leave WRH Hospital Implementation of the Acute Medical Programme (AMP) -will Q2 1,2,4,5, 6,7,8, 14 Services contribute to reduction in Average Length of Stay (ALOS) for HSE South 108
APPENDIX 3
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Acute Medicine in line with NSP 12/SDU targets WRH Hospital Efficiencies - Demand Management Regional Laboratory Services Q1 2, 4, 5, 7, 8, 15 Services - Community and Hospital WRH Hospital Efficiencies in Medical Pay Budget –Minimisation of agency, locum Q1 1, 2, 4,6,7,8, 14 Services cover limited to 1:3 rotas – restructuring of replacement consultant posts WRH Hospital Clerical / Admin - Reorganisation of Clerical/Administration staff to Q2 1, 3, 6,7,8,10, 14 Services facilitate the continued provision of secretarial support services to medical staff in WRH and to provide secretarial support services to existing, new consultants and services and to ensure admin support to clinical area including cross-cover to cover short-term absences. WRH Hospital Support Services - Review of Portering/Attending support services Q2 1, 2, 3, 8, 14 Services to maximise efficiency and utilisation of staffing resource WRH Hospital Support Services - Review of current theatre porter service to Q2 1, 2, 3, 8, 14 Services ensure that theatres are fully supported and in line with TPOT initiative WRH Hospital Realignment of staff all grades & disciplines to support rollout of Q4 1,2, 3, 4, 6, 7, 8,10, Services national clinical Programmes (NDQCC) – Acute Medicine 11, 12, 14 Programme, and all clinical programmes including new Corporate and Clinical Governance Structures and Reporting arrangements as set out in NSP 2011. The National Clinical Programmes will require changes in working practices across all grades and disciplines but will have a specific impact on Clinical staff and Depts., Medical, Nursing and H&SCPG, Pharmacy and all support staff grades. WRH Hospital Reorganise catering service delivery model to support service level Q4 1,3, 7, 11 Services needs WGH Hospital Radiology Department - Extend the Working Day and review on Q1 12,13,14 Services call arrangements for Clinical Staff in line with the Extended Working for Radiography Grades Agreement WGH Hospital Technical Services Department - Review of rosters and on call Q1 14 Services agreements with a view to introducing an extended working day. WGH Hospital Administration - Temporary reassignment of staff to Ambulance Q1 1 Services Service WGH Hospital Physiotherapy Department - Extended working day to facilitate Q1 12,13,14 Services early morning/late afternoon/early evening appointments in Physiotherapy WGH Hospital Theatre Department - Further revision of nursing roster and on call Q1 13, 14 Services arrangements within the Theatre Department. All service Management / Administrative functions - re-configuration and 2012 1,2,5 areas reassignment of management & administration, local manpower planning to be undertaken to maximise efficiencies through revised working arrangements and introduction of IT
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APPENDIX 3 PSA Initiatives – Carlow / Kilkenny & South Tipperary Area
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Carlow / Reorganisation Nurse Management revision of on-call system Kilkenny Mental Health Q1 6, 14 in Carlow, LHO - In line with National Strategy 'Vision for Change', Carlow / Carlow/Kilkenny Mental Health Service has been reorganised Kilkenny Mental Health Q1 1, 3, 4, 13 through a comprehensive Hostel review process and the LHO closure of St. Patrick's Ward at St. Dympna's Hospital, Carlow. Carlow / Integrated management of Consultants annual leave in Kilkenny Mental Health Q1 6, 13, 14 Carlow/Kilkenny Mental Health Services. LHO South Tipperary Mental Health Minimisation of NCHD overtime and on call Q2 6, 13 LHO Integrated management of locum replacement for annual leave of Consultants. Potential savings from integrated South approach to management of annual leave for the five Tipperary Mental Health Q2 6, 13, 14 Consultants in South Tipperary Mental Health Services. Child LHO & Adolescent services to be maintained in current format to ensure ongoing service delivery. South Damien House Services revised rosters to include the Tipperary Disability Q1 1, 14 introduction of 'sleep-overs' to meet service demands LHO South Damien House Services Reassignment of duties to support Tipperary Disability day services due to reorganisation of services in dedicated Q1 1, 6 LHO day service house South Home Care Support Implementation of hours in line with 2012 Tipperary Disability Q1 1 target levels LHO Carlow / Home Help Services Implementation of Home Help hours Kilkenny Older People Q1 1, 13 target hours in line with 2012 target levels LHO Consolidation of Elderly Care Beds in Carlow / Kilkenny Carlow / (Long-Stay Re-organisation and consolidation of Elderly Long Kilkenny Older People Q1 1, 2, 14 Stay beds in Sacred Hospital, Carlow & St. Columba's and LHO associated changes to rostering and skill mix Consolidation of Elderly Care Beds in Carlow/Kilkenny (District Carlow / Hospitals-This proposal consolidates the provision of Kilkenny Older People Q1 1, 2, 14 community support beds (respite, convalescence and LHO associated changes to rostering and skill mix South Home Help Services: Home Help Services Implementation of Tipperary Older People Q1 1, 13 Home Help hours target hours in line with 2012 target levels LHO Consolidation of District Hospital services in South Tipperary South i.e. St. Brigid's Hospital Carrick-on-Suir and St. Teresa's Tipperary Older People Q1 1, 5 & 14 Hospital, Clogheen and associated changes to rostering and LHO skill mix South Long-Stay Elderly Beds South Tipperary- Consolidation of Tipperary Older People provision of Long Stay Elderly care beds and associated Q1 1, 5 & 14 LHO changes to rostering and skill mix Carlow / Kilkenny Older People Reorganisation of Public Health Nursing services Q1 1, 3 LHO Carlow / Children and Reduction Agency Costs & greater efficiency in Staff Rosters Kilkenny Q1 12, 13, 14 Families and skill mix LHO
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APPENDIX 3
Location Area of One line description of Change Timeframe PSA Modernisation Health Sectoral Agreement Section 2.9 Measures 1-15 Carlow / Children and Kilkenny Restructuring of Children and Families Psychology Services. Q1 1, 4, 13 Families LHO SLGH and Hospital Surgical Programme implementation of programme involving Q1 8, 10, 14 Kilcreene Services the internal deployment of staff and skill mix opportunities Acute Medical Programme. implementation of programme SLGH and Hospital involving the internal deployment of staff and skill mix Q1 8, 10, 14 Kilcreene Services opportunities Laboratory, Equipment, Radiology, Transport & Contract SLGH and Hospital savings. - New automation being introduced for blood Q1 15 Kilcreene Services transfusion. This will reduce overtime required for B SLGH and Hospital Limited Consultant Cross-cover of leave for Radiology and all Q1 6, 12 Kilcreene Services specialities where there is a greater than 1:3 ratio. SLGH and Hospital Revise NCHD rotas further to provide for a cost-effective Q1 6, 12, 14 Kilcreene Services delivery of NCHD on-call services across all specialities Radiography and Laboratory Payroll Costs. - Reduction in SLGH and Hospital costs in line with nationally agreed Laboratory & Radiology Q3 12, 13, 14 Kilcreene Services agreements Administrative efficiencies - Overtime & Agency reductions. SLGH and Hospital This involves changes to staff rostering, planned annual leave Q1 1, 11, 12 Kilcreene Services to tie in with seasonal reductions, flexibility in assignment of duties Support Staff: Reorganisation of work rosters under the PSA SLGH and Hospital in portering, catering, housekeeping and maintenance Q1 14 Kilcreene Services services National Clinical Programmes Refocusing patient Hospital management pathways to match National performance STGH Q1 8, 10, 14 Services requirements, Clinical Programme initiatives involving the internal deployment of staff and skill mix opportunities Workforce Planning/Reorganisation - STGH is engaged in Hospital STGH an ongoing process of reorganisation and redeployment of Q1 1, 4, 13 Services staffing resources Full-year effect of 2011 changes to NCHD rosters reducing Hospital STGH actual hours paid, unrostered overtime, rostered overtime and Q1 6,14 Services agency usage across all specialities. Hospital Radiography on-call.- Reduction in costs in line with STGH Q2 6 Services impending national Radiology agreement Management / Administrative functions - re-configuration and All reassignment of management & administration, local All service areas 2012 1,2,5 Locations manpower planning to be undertaken to maximise efficiencies through revised working arrangements and introduction of IT
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